Dr Sarah Brewer August 23, 2019

Indigestion, reflux and heartburn are common names for unpleasant digestive symptoms associated with eating. But how can you tell which one you're suffering from? We take a closer look

Indigestion

Also called dyspepsia, indigestion is a general term used to describe discomfort felt centrally in the upper abdomen. This includes feelings of distension, flatulence, nausea, acidity and abdominal pain which may be due to irritation of the stomach lining, trapped 'wind' or excessive contraction of the stomach wall. Indigestion can also result from insufficient production of stomach acid, bile or pancreatic secretions, all of which become increasingly common with age. Reduced production of stomach acid (hypochlorhydria) or even a total lack of acid production (achlorhydria) affects as many as one in five people in their 50s, rising to almost one in three of those aged 60 or more.1

Heartburn

This is a more specific term for hot, burning sensations, felt behind the chest bone, which may spread up toward the throat. The usual cause of heartburn is acid reflux.

Acid reflux

During acid reflux, the stomach contents pass up into the oesophagus - the tube connecting the mouth and stomach. This brings stomach acids and enzymes into contact with the sensitive lining of the oesophagus which, as well as causing burning, can trigger painful spasm of surrounding muscles. GERD (gastroesophageal reflux disease) is the chronic, more severe form of acid reflux. Normally, acid reflux is prevented by a valve-like mechanism between the stomach and oesophagus which pinches the lower oesophagus closed.

This mechanism can fail with age, in people with a hiatus hernia (in which part of the stomach slips up through a natural gap in the diaphragm to enter the chest cavity) or due to increased pressure on the stomach – for example from pregnancy or being overweight. Some people with acid reflux do not experience obvious symptoms and this 'silent reflux' may contribute to some cases of hoarseness, voice problems, cough, sensations of a lump in the throat and repeated throat clearing.

Lifestyle changes

Certain lifestyle changes can help manage digestive symptoms:

  • Lose some excess weight. Even a small amount of weight loss, of around 4kg, can reduce the severity of heartburn and acid reflux by 75%.2
  • Avoid coffee as this relaxes the ring of muscle between the stomach and oesophagus which can cause or aggravate heartburn.3
  • Aim to eat little and often throughout the day rather than having three large meals.
  • Take care not to stoop, bend or lie down immediately after eating.
  • Avoid late-night eating as this increases the risk of indigestion waking you - digestion slows when you are asleep and lying flat makes reflux more likely. Elevating the head of the bed by 15-20 cm can help if symptoms come on when lying down.
  • Avoid smoking cigarettes.
  • Wear lose clothing, especially around the waist.
  • Avoid aspirin and related drugs (eg ibuprofen) which can irritate the stomach lining.
  • Try to stay calm. Stress is thought to be a major cause of indigestion.

Dietary changes

Watching what you eat can also make a big difference

  • Avoid rich food (eg cream sauces) or ‘heavy’ foods (eg pastry, gateaux, cheesecake) as well as acidic fruit juices which commonly trigger indigestion or heartburn.
  • Eating bland, non-acidic, easily digestible foods is usually recommended, such as cooked white rice, oats, scrambled eggs, ripe bananas, well-cooked green leafy vegetables and chicken broth.
  • Milk and plain yoghurt are especially helpful as they provide calcium salts that help to neutralise excess acid. Probiotic bacteria in live yoghurt help to promote good digestion. Eating live Bio yoghurt and taking probiotic supplements also inhibit the growth of bacteria (Helicobacter pylori) that can irritate the stomach lining to cause indigestion symptoms.4

References
1Krasinski, D.D. et al. (1986). Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc 34(11)
2Fraser-Moodie, C.A. et al. (1999). Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight. Scand J Gastroenterol 34(4)
3Thomas, F.B. et al. (1980). Inhibitory effect of coffee on lower esophageal sphincter pressure. Gastroenterology 79(6)
4Chen, Y.H. et al. (2019). Probiotic Lactobacillus spp. act Against Helicobacter pylori-induced Inflammation. j Clin Med 14;8(1)

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn't possible, supplements can help. This article isn't intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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