What is it?

Indigestion (also known as dyspepsia) is a feeling of discomfort after eating. This is a very common condition and most people will experience this at some point.

Symptoms

• Heartburn (a painful feeling of burning in the chest, usually felt after eating)

• Feeling full and bloated

• Flatulence

• Nausea

• Bring up food and/or bitter-tasting fluids into the mouth

Red flag symptoms

If a patient presents to the community pharmacy with any of the following symptoms they must be referred:

ALARM symptoms require further investigation therefore the patient should be urgently referred to the GP.

A - anaemia (fatigue, paleness, shortness of breath)

L - loss of weight

A - anorexia

R - recent onset of progressive symptoms

M - melaena (dark, black stools), dysphagia (swallowing difficulties), and haematemesis (blood in vomit)

• Severe, debilitating pain or pain which awakes the patient at night - suggests ulceration

• Persistent vomiting

• Referred pain - possibly cardiovascular or biliary cause

Treatment Options

Over the counter (OTC):

• Antacids/Alginates e.g., Gaviscon and Peptac (Note: some antacid preparations such as Gaviscon Advance contain significantly large amounts of sodium which is linked to hypertension)

• H2 antagonists e.g., ranitidine (no longer available OTC in the UK)

• Proton pump inhibitors e.g., esomeprazole (Nexium)

Prescription only medicines (POMs):

• H2 antagonists e.g., cimetidine, famotidine

• Proton pump inhibitors (PPIs) e.g., lansoprazole, omeprazole, pantoprazole

Lifestyle advice:

• Lower fat diet and avoid spicy foods

• Avoid eating 3-4 hours before bed

• Avoid ibuprofen and aspirin unless prescribed

• Keep alcohol intake to recommended levels (maximum 14 units per week aka. ~6 pints of beer)

• Stop smoking - smoking cessation service

• Weight loss, if the patient is overweight

• Reduce caffeine intake

• Raise head slightly when sleeping to help prevent stomach acid coming up when sleeping

Treatment summary:

• Antacids/Alginates such as Gaviscon and Peptac work for most people presenting with mild dyspeptic symptoms. Liquid formulations are preferable as the acid-neutralising capacity and speed of onset is greater.

• PPIs are preferred in moderate-severe or recurrent dyspepsia.

Mechanism of action:

Antacids = These contain a combination of various compounds containing various salts of magnesium, calcium and aluminium. These medicines work by neutralising the acid in the stomach and inhibiting the enzyme pepsin (a proteolytic enzyme in the stomach).

H2 antagonists = These medicines reduce gastric acid secretion by reversibly binding to histamine H2 receptors (competitive antagonists) located on parietal cells.

Proton pump inhibitors = These medicines block secretion of gastric acid by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump on the cell membrane of the parietal cells.

Safety net

If symptoms don’t improve or worsen following treatment come back to the pharmacy or visit the GP. Individual products will specify how long they can be used for until seeking medical advice. Go to the GP if experiencing any of the red flag symptoms (mentioned above).

Book recommendation

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