Your Health  -   A to Z of Common Medical Conditions

Indigestion / Ulcer / Heartburn

Description - Everybody gets indigestion at some time, many people get it frequently. The usual symptom is discomfort in the lower chest and upper abdomen, often relieved by drinking milk or taking an antacid. Sometimes indigestion is accompanied by nausea and vomiting. Situations causing indigestion include eating too much, eating too fast, eating things known to "upset", eating at irregular intervals and eating when very tired. Other causes include smoking, drinking too much alcohol, general illness such as influenza, almost any chronic illness, many medications and psychological states such as anxiety. The presence of the bacterium Helicobacter pylori in the stomach makes indigestion much more likely and is invariably found when peptic ulcers are present. Peptic ulcers -gastric and duodenal - less common than they were fifty tears ago, are a significant step on from indigestion. Unlike indigestion, they can cause grave illness or death from perforation or acute haemorrhage. They can also cause chronic ill health from pain and continuing blood loss (see Anaemia). The pain from an ulcer is usually more severe than pain from indigestion, often gnawing in nature, it sometimes goes through to the back. The pain of a gastric ulcer usually comes on soon after eating, that of a duodenal ulcer half an hour or so later. Both types of ulcer are irritated by the presence of stomach acid and other peptic juices. In duodenal ulceration there is usually an excess of acid. Both are made worse by smoking.  Heartburn is a sensation of burning felt in the middle of the chest resulting from the acid contents of the stomach coming up (reflux) into the oesophagus (gullet) and irritating its sensitive lining. This can produce a chronic irritation, oesophagitis, which is often accompanied by a burning sensation behind the breastbone on swallowing. Heartburn (gastro-oesophageal reflux) can be caused, amongst other things, by a weakness in the muscles that keep digesting food and gastric juice in the stomach ( hiatus hernia), pressure on the stomach that may be caused by obesity or frequent bending, or factors that may relax the sphincter inappropriately such as smoking and alcohol.

Management - Many people know what causes their indigestion and can avoid it if they wish to. This particularly applies to highly spiced food, smoking and excess alcohol. If indigestion, or heartburn, continues for more than a few days or comes on unexpectedly after the age of 40, the doctor should be consulted. Such symptoms, these days, are usually investigated by endoscopy where a fibre optic tube is put down the gullet and the interior of the oesophagus, stomach and duodenum examined. Physical abnormalities, such as ulcers and hiatus hernia, can be detected as can the presence of Helicobacter. Early, still treatable, cancer may also be found. Simple treatment of indigestion includes advice, particularly on those factors such as smoking which should be avoided, and the use of antacids. People with heartburn receive similar advice and should also avoid bending, or going to bed, straight after a heavy meal. Medications containing alginates, as well as antacids, can help heartburn. Modern medical treatment of ulcers and reflux problems include medications that suppress the production of gastric acid and antibiotics that will eradicate Helicobacter pylori.

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