Indigestion and heartburn are gastrointestinal issues experienced by many people

Although patients often talk about indigestion and heartburn as a single problem, they are in fact separate conditions. Or more specifically, indigestion is a condition, while heartburn is a symptom.

Indigestion (dyspepsia) is a functional condition in which the gastrointestinal organs, primarily the stomach and first part of the small intestine (and occasionally the esophagus), function abnormally. Heartburn is a symptom caused by reflux of acidic stomach contents into the oesophagus, resulting in irritation and burning.

Heartburn can be a symptom of indigestion (since indigestion is a collection of symptoms) however heartburn is also its own distinct symptom. Indigestion, on the other hand, isn’t related to stomach acid.

Dr Abram Eisenstein, Director of Gastroenterology at Cooper Clinic, explains that one can distinguish between indigestion and heartburn by the fact that they happen in completely different parts of the body. Heartburn is a symptom which manifests as pain in the throat or neck, and a burning in the chest area. Indigestion on the other hand causes chronic burning pain in the upper and lower abdomen and a feeling of fullness after just a few bites.

The good news explains Eisenstein is that both problems are often caused by lifestyle decisions rather than simply the food we eat. “This includes how much food we eat, how fast we eat it, and how late at night we eat. The stomach is the most sensitive stress reactor. Therefore stress is another common cause for heartburn or indigestion.” As a result, by changing eating and lifestyle habits patients can manage the conditions and alleviate the pain that accompanies their symptoms.

“Other causes for both conditions may be the medications we take, both prescription and over-the-counter (OTC). Important risk factors to note for heartburn include obesity and use of tobacco.”

Indigestion

Indigestion (the medical term for which is dyspepsia) includes a number of symptoms and can often be a sign of some other health condition. “Indigestion basically means ‘poor digestion’ and describes some sort of disturbance in digestion in the initial stages of digestion (usually in and around the stomach rather than the bowels),” explains Nutritional therapist Ali Cullen.

The University of Miami Hospital defines indigestion as a painful or burning feeling in the upper abdomen and usually accompanied by nausea, bloating or gas, a feeling of fullness, and, sometimes, vomiting. While indigestion may be the result of a disease or an ulcer in the digestive tract, most often it is the result of eating too much, eating too quickly, eating high-fat foods, or eating during stressful situations.

Location Of Discomfort

“Indigestion occurs in the upper abdomen just under the breast bone,” explains Eisenstein. It is a burning discomfort in the stomach, sometimes likened to hunger pains – except that it occurs on a full stomach too. One similarity between heartburn and indigestion, and a general precaution, is that chest discomfort due to a heart attack may be incorrectly attributed to either heartburn or indigestion instead.

Cause

Indigestion is caused when the stomach acid comes into contact with the mucosa that lines the stomach to protect it from the acid. The stomach acids break down the lining, causing the stomach acid to irritate and inflame the stomach.

According to the National Institute of Diabetes and Digestive and Kidney Diseases some of the common causes of indigestion include:

  • Drinking
    • too many alcoholic beverages
    • too much coffee or too many drinks containing caffeine
    • too many carbonated, or fizzy drinks
  • Eating
    • too fast or too much during a meal
    • spicy, fatty, or greasy foods
    • foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
  • Stress
  • Smoking
  • Certain medicines
  • some antibiotics—medicines that kill bacteria
  • nonsteroidal anti-inflammatory drugs

Health problems and digestive tract diseases and conditions that can cause indigestion, include:

  • acid reflux (GER and GERD)
  • anxiety or depression
  • gallbladder inflammation
  • gastritis
  • gastroparesis
  • Helicobacter pylori (H. pylori) infection
  • irritable bowel syndrome
  • lactose intolerance
  • peptic ulcer disease
  • stomach cancer

Symptoms

Indigestion is a chronic disease in which the symptoms fluctuate in frequency and intensity usually over many months or years. It may occur every day or intermittently for days or weeks at a time followed by days or weeks of relief (a pattern referred to as periodicity).

Indigestion may be accompanied by a variety of other symptoms. It’s important to remember that each person’s symptoms may vary. These symptoms may include:

  • Feeling full too soon while eating
  • Pain, burning, and discomfort in the upper belly or abdomen
  • Feeling bloated
  • Poor appetite
  • Burping and loud stomach gurgling
  • Acidic taste
  • Nausea or vomiting
  • Constipation
  • Diarrhoea
  • Flatulence

These symptoms may increase in times of stress.

Sometimes when you have indigestion, you may also have heartburn. However, heartburn and indigestion are two separate conditions. Unlike heartburn which can cause you to awaken at night with pain or discomfort, indigestion usually does not awaken you.

Treatment

The National Institute of Diabetes and Digestive and Kidney Diseases advises that treatment for indigestion depends on the cause and may include:

  • OTC and prescription medicines
  • Changing what you eat and drink
  • Psychological therapies

OTC And Prescription Medicines

You can buy many medicines to treat indigestion without a prescription, such as antacids, H2 blockers, or proton pump inhibitors. However, should the indigestion lasts longer than two weeks, the patient should see a doctor. The doctor may prescribe acid-suppressing medicines that are stronger than those one can buy, antibiotics, prokinetics, or psychological medicines.

Antacids

Doctors often first recommend antacids – OTC medicines that neutralise acids in the stomach. Antacids include:

  • Calcium carbonate
  • Loperamide
  • Simethicone
  • Sodium bicarbonate

Antibiotics

To treat a Helicobacter pylori (H. pylori) infection, a doctor will prescribe antibiotics, which kill bacteria. He or she will prescribe at least two of the following:

  • Amoxicillin
  • Clarithromycin
  • Metronidazole
  • Tetracycline
  • Tinidazole

H2 blockers

H2 blockers are medicines that decrease the amount of acid the stomach produces. H2 blockers provide short-term or on-demand relief for many people with indigestion. H2 blockers include:

  • Cimetidine
  • Famotidine
  • Nizatidine
  • Ranitidine

Proton pump inhibitors (PPIs)

PPIs are most effective in treating indigestion when patients also have heartburn. PPIs include:

  • Esomeprazole
  • Lansoprazole
  • Omeprazole
  • Pantoprazole
  • Rabeprazole

Prokinetics

Prokinetics help the stomach empty faster. Prescription prokinetics include

  • Bethanechol
  • Metoclopramide

Changes in what a person eats and drinks

A doctor may recommend avoiding certain foods and drinks that may cause indigestion or make symptoms worse, such as:

  • Alcoholic beverages
  • Carbonated, or fizzy, drinks
  • Foods or drinks that contain caffeine
  • Foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
  • Spicy, fatty, or greasy foods

Psychological therapies

A doctor may recommend a type of psychological therapy called “talk therapy” to help treat anxiety and depression that may be causing indigestion. If stress is causing indigestion, a doctor may recommend ways to help reduce stress, such as meditation, relaxation exercises, or counselling. Talk therapy can also help a patient learn how to reduce their stress.

Prevention

There are many things patients can do to try to prevent indigestion. The University of Rochester Medical Centre recommends:

  • Making changes in your diet and eating habits can help. These include:
    • Eating several small, low-fat meals each day instead of three large meals
    • Eating slowly and giving yourself enough time for meals
    • Limiting spicy, fatty, greasy, or high-fibre foods
    • Chewing your food well
    • Limiting or not having any coffee, soda, or alcohol
  • Avoid medicines that hurt your stomach. These include aspirin and OTC pain and fever medicines (NSAIDs or nonsteroidal anti-inflammatory drugs). If you do take them, do so after you eat.
  • Other lifestyle changes that may keep indigestion from happening include:
    • Quitting smoking
    • Getting enough rest
    • Finding ways to lower emotional and physical stress, such as meditation or yoga
    • Exercising before a meal or waiting at least one hour after eating

Heartburn

“Heartburn is a symptom of indigestion and usually describes the intense, burning feeling (hence the name) in the chest behind the breastbone which occurs as stomach acid travels backwards from the stomach into the oesophagus,” explains nutritional therapist Ali Cullen. “Heartburn is usually a result of indigestion and can be so severe people often mistake it for a problem with their heart.”

The pain of heartburn is the irritation or damage taking place to your oesophagus by the refluxed stomach acid.

Location Of Discomfort

Heartburn is a painful burning sensation in the oesophagus, just below or behind the breastbone. The pain often rises in your chest and may radiate to your neck or throat.

Cause

Essentially heartburn is caused by acid reflux or when the digestive acid flows up into the oesophagus. According to the University of Maryland Medical Center, normally when food or liquid enters your stomach, a band of muscle at the end of your oesophagus closes off the oesophagus. This band is called the lower oesophageal sphincter (LES). If this band does not close tightly enough, food or stomach acid can back up (reflux) into the oesophagus. Usually acidic, the stomach contents can irritate the oesophagus and cause heartburn and other symptoms.

Heartburn is more likely if you have a hiatal hernia. A hiatal hernia is a condition which occurs when the top part of the stomach pokes into the chest cavity. This weakens the LES so that it is easier for acid to back up from the stomach into the oesophagus.

Pregnancy and many medicines can bring on heartburn or make it worse.

Medicines that can cause heartburn include:

  • Anticholinergics (used for sea sickness)
  • Beta-blockers for high blood pressure or heart disease
  • Calcium channel blockers for high blood pressure
  • Dopamine-like drugs for Parkinson disease
  • Progestin for abnormal menstrual bleeding or birth control
  • Sedatives for anxiety or sleep problems (insomnia)
  • Theophylline (for asthma or other lung diseases)
  • Tricyclic antidepressants

Symptoms

Symptoms of heartburn include: burning feeling (in the chest or behind the breast bone), chest pain, burning in the throat, hot-sour or acidic taste in the back of the throat, difficulty swallowing, feeling of sickness or nausea, feeling of food sticking in the middle of chest or throat, coughing, sore throat, etc. Other rare symptoms include pain in the back, jaw, shoulders, neck or arms.

Treatment

While occasional heartburn happens to most people at some point, Georgetown University Medical Centre cautions patients to pay attention to heartburn and treat it, especially if symptoms are experienced often. Over time, ongoing reflux can damage the lining of your oesophagus and cause serious problems.

In some cases heartburn responds to lifestyle changes. Avoiding trigger foods, shedding excess weight, not eating too close to bedtime and elevating the head of the bed are all potentially helpful. Eating smaller meals, eating more slowly, not smoking or consuming alcohol and reducing stress may be helpful as well.

If you still do not have full relief, try OTC medicines:

  • Antacids help neutralise stomach acid
  • H2 blockers reduce stomach acid production
  • Proton pump inhibitors stop nearly all stomach acid production

Prevention

The University of Maryland Medical Center advises that changing your habits can be helpful in preventing heartburn.

  • First, avoid foods and drinks that can trigger reflux, such as:
    • Alcohol
    • Caffeine
    • Carbonated drinks
    • Chocolate
    • Citrus fruits and juices
    • Peppermint and spearmint
    • Spicy or fatty foods, full-fat dairy products
    • Tomatoes and tomato sauces
  • Next, try changing your eating habits:
    • Avoid bending over or exercising just after eating
    • Avoid eating within 3-4 hours of bedtime. Lying down with a full stomach causes the stomach contents to press harder against the lower oesophageal sphincter (LES)
    • Eat smaller meals.
  • Make other lifestyle changes as needed:
    • Avoid tight-fitting belts or clothes that are snug around the waist. These items can squeeze the stomach, and may force food to reflux
    • Lose weight if you are overweight. Obesity increases pressure in the stomach. This pressure can push the stomach contents into the oesophagus. In some cases, GERD symptoms go away after an overweight person loses 4-8kgs
    • Sleep with your head raised about 6 inches. Sleeping with the head higher than the stomach helps prevent digested food from backing up into the oesophagus. Place books, bricks, or blocks under the legs at the head of your bed. You can also use a wedge-shaped pillow under your mattress. Sleeping on extra pillows does NOT work well for relieving heartburn because you can slip off the pillows during the night
    • Stop smoking. Chemicals in cigarette smoke weaken the LES
    • Reduce stress. Try yoga, tai chi, or meditation to help relax