What Causes Heartburn and Indigestion?

Indigestion is also known as dyspepsia. About 25% of the general population is affected by dyspepsia, with each person describing their symptoms differently – stomach pain, stomach ache, heartburn, bloating, or fullness after only small amounts of food.

For many people, dyspepsia only occurs once in a while, so they might take an over-the-counter antacid from time to time and never seek medical attention. For other people, the symptoms may be more frequent or more bothersome, such that their ability to enjoy their daily activities is affected. Others may be worried that the dyspepsia is a sign of a more serious condition.

Dyspepsia may also be caused by prescription or over-the-counter medications. ASA (also known as acetylsalicylic acid; e.g., Aspirin® and generics) can upset the stomach even in small amounts. Nonsteroidal anti-inflammatory drugs (also called NSAIDs) can also cause dyspepsia. Some NSAIDs are available over the counter, like ibuprofen, while many others are available with a prescription. Other medications known to upset the stomach include potassium supplements, iron supplements, niacin, some antibiotics, codeine-containing (or other narcotic) pain medications, steroids (e.g., prednisone), and estrogens. If you are taking an over-the-counter or prescription medication and are wondering if it could be causing your upset stomach, ask your pharmacist. He or she may be able to advise you on the best way to take the medication to reduce the effect on the stomach.

Some foods are frequently blamed for causing dyspepsia. Coffee (both caffeinated and decaffeinated) and spicy and fatty foods are often implicated. For people who are unable to absorb lactose, dairy products may cause cramps, bloating, gas, and diarrhea. Alcohol is also commonly associated with upset stomach. Psychological problems or stressful life events may make symptoms worse and can affect treatment.

In some cases, medical conditions can cause dyspepsia. Gastroesophageal reflux disease (GERD) is a condition where the acid normally found in the stomach to digest food backs up abnormally into the esophagus (food pipe). This condition can cause heartburn and indigestion. Your doctor may recommend medication and non-medication options (lifestyle changes) to relieve the symptoms of heartburn. For most people, this relieves the problem. But in some cases, your doctor may request a test whereby a tube is put down to examine the esophagus. This test is called an endoscopy.

Your doctor may request an endoscopy if your symptoms do not respond to medication, or if you are having difficulty or pain when swallowing, unexplained weight loss, or symptoms of bleeding (such as vomit that looks like coffee grounds or black, tarry stools). The test is done to diagnose and treat certain complications of GERD, such as narrowing of the esophagus. It is also used to rule out other causes of your symptoms, so that your doctor can recommend an appropriate treatment.

Peptic ulcers, which are ulcers in the stomach or duodenum (a part of the intestine just below the stomach), can cause dyspepsia. However, most people with dyspepsia do not have ulcers. Peptic ulcers are more common in people over 40 years of age, men, people who take NSAIDs, those who have a type of bacteria in their stomach mucus called Helicobacter pylori, people with a history of peptic ulcer disease, and smokers.

One of the common types of dyspepsia is functional dyspepsia. People with functional dyspepsia have no identifiable cause. Perhaps the stomach is not relaxing properly after a meal. Or the rate of stomach emptying may be too slow.

You should see your doctor as soon as possible if you have:

• dyspepsia starting after 50 years of age
• unintended weight loss
• anemia or low iron in your blood (you may look pale or feel tired and weak)
• vomit that looks like "coffee grounds" (seek immediate medical attention)
• black, tarry stools (seek immediate medical attention)
• difficulty swallowing
• persistent vomiting
• severe abdominal pain

What can be done to lessen the symptoms of dyspepsia?

Non-medication treatment options include lifestyle changes such as healthy eating, maintaining a healthy weight and stopping smoking. Medications include a family of medications known as proton pump inhibitors (PPIs), a family of medications known as histamine-2 receptor antagonists (H2RA), and, in some cases, treatment for Helicobacter pylori infection in the stomach using PPIs and antibiotics.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/What-Causes-Heartburn-and-Indigestion

What is heartburn?

Heartburn is often described as a burning pain just below or behind the breastbone. Some describe the pain as rhythmic or coming in waves from the stomach up toward the chest or the throat. For some people the pain is associated with large or fatty meals, and some experience pain during the night that disturbs their sleep.

It's common for pregnant women to suffer from heartburn. And many people have had the occasional bout of heartburn after a big meal or some spicy food. But for some people, heartburn symptoms happen much more often.

Frequent heartburn can be a classic symptom of a condition called gastroesophageal reflux disease (GERD). How do you know if your heartburn is a symptom of GERD? Your doctor will likely diagnose GERD based on a description of the symptoms and their frequency.

The frequency and severity of symptoms are not good indicators of the degree of esophageal damage. In order to assess esophageal damage, you may need a test called an endoscopy, where a tube is put down to look at the lining of the esophagus. In many cases, though, endoscopy is only done if treatment with medication is not effective, since doctors will often prescribe medications first as a simple diagnostic test for GERD. If the person's symptoms respond to medication, then the doctor concludes that the symptoms were caused by GERD. If not, then further tests, such as endoscopy, are needed.

What causes GERD?

The esophagus is the passageway that carries food from the mouth to the stomach. Because the job of the esophagus is to transport food, the lining of the esophagus is only meant to come in contact with stomach acid for short periods of time. Between the esophagus and the stomach there is a closure so that contents from the stomach will not back up into the esophagus. And if they do, the esophagus is normally able to work the contents back down into the stomach and neutralize the acid.

In people with GERD, the stomach acid remains in the esophagus longer than normal. This happens either because the closure between the stomach and the esophagus is not working well or because the esophagus is not able to work the contents back down and neutralize the acid. Other factors may be the amount of stomach contents or the amount of stomach acid.

Saliva is one of the ways the body effectively neutralizes any stomach acid in the esophagus. While we sleep, the amount of saliva decreases. This may contribute to heartburn symptoms at night. Smoking decreases saliva production and nicotine probably affects the closure between the stomach and the esophagus.

Certain foods can make the closure between the esophagus and the stomach not work well – fatty foods, chocolate, and peppermint are some examples. Many prescription medications can also weaken the closure. Obesity is another potential risk factor for GERD.

Can GERD lead to long-term problems?

Long-standing untreated GERD can lead to irritation of the lining of the esophagus (called esophagitis) and scarring of the esophagus. These scars are called strictures and can make swallowing difficult because the esophagus becomes narrower.

Untreated, long-term GERD can cause other problems. Some people with GERD will have cell changes in the lining of the esophagus because of the long-term exposure to stomach acid. This is called Barrett's esophagus and requires regular check-ups, as people with Barrett's esophagus are at increased risk of developing cancer of the esophagus.

When should I see my doctor about heartburn?

If you are bothered by symptoms of heartburn, or if the symptoms are interfering with your sleep or your daily activities, see your doctor. There are medications and non-medication options (lifestyle changes) that your doctor can recommend that may help.

You should also see your doctor as soon as possible if you have:

• symptoms starting after 50 years of age
• unintended weight loss
• anemia or low iron in your blood (you may look pale or feel tired and weak)
• vomit that looks like "coffee grounds" (seek immediate medical attention)
• black, tarry stools (seek immediate medical attention)
• difficulty swallowing
• persistent vomiting
• severe abdominal pain

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/What-Causes-Heartburn-and-Indigestion

In the stomach, there are protective substances that guard the stomach lining against damage. There are also aggressive substances, like stomach acid, that help to digest food. An ulcer forms because of an imbalance between the protective and aggressive factors in the stomach. The term peptic ulcer can mean an ulcer in the stomach or an ulcer in the duodenum (the first part of the intestine below the stomach).

Helicobacter pylori, or H. pylori, bacterial infection is another important factor in either causing ulcers or making ulcers harder to heal. About 80% to 90% of ulcers may be associated with H. pylori infection in the stomach. The H. pylori bacteria may lead to increased acid production in the stomach and may decrease the protective factors in the duodenum leading to peptic ulcers. H. pylori infection may also increase the risk of stomach cancer. For these reasons, many people are tested for H. pylori and prescribed a special combination of medications to get rid of H. pylori infection.

Where does H. pylori come from? How do you get it?

How helicobacter pylori infects a person is still unknown. It may be passed from person to person by direct contact with saliva, vomit, or fecal material. For example, if you touch a surface contaminated with fecal material and then touch your mouth you can unknowingly swallow fecal matter.

How do I know if I've got it, and if I've got it, how do I get rid of it?

Your doctor can order a simple breath test to determine if you have H. pylori or not. Other methods of detection include stool samples, blood tests, and biopsies (where a sample of tissue is taken).

Treatment to rid a person of H. pylori involves using a combination of medications – often a proton pump inhibitor (PPI) and three antibiotics or two antibiotics with bismuth subsalicylate (Pepto Bismol®). It is important to take the medication exactly as directed to increase the chances that the treatment will work.

What role do NSAIDs and ASA play in ulcers?

Nonsteroidal anti-inflammatory drugs (NSAIDs), often taken for arthritis pain, are an important cause of ulcers. NSAIDs prevent the production of a substance that protects the stomach. NSAIDs also directly irritate the lining of the stomach. People who take NSAIDs regularly are at increased risk of developing an ulcer. Peptic ulcers caused by NSAIDs may sometimes lead to complications such as gastrointestinal bleeding.

People taking NSAIDs every day are more likely to develop a peptic ulcer compared to others who take NSAIDS occasionally.

ASA (also known as acetylsalicylic acid; e.g., Aspirin® and generics) is often prescribed in low doses to reduce the risk of stroke or heart attack (for people who have already had a stroke or heart attack). It helps to keep the blood from clotting where it shouldn't. Because ASA used in this way is important for your heart, do not stop taking it because you are afraid it will give you an ulcer. Instead, speak to your doctor for more information.

Not everyone who takes ASA or NSAIDs will get an ulcer. Things that increase the risk are a past history of an ulcer, advanced age, taking higher doses, taking ASA together with an NSAID, taking 2 or more NSAIDs, regularly consuming alcohol while also taking ASA or NSAIDs, and infection with H. pylori.

If you are at greater risk of developing an ulcer from ASA or NSAIDs, your doctor may prescribe a medication to help prevent an ulcer from forming or to treat an infection with H. pylori. If you'll be taking ASA or NSAIDs for the long term, your doctor may recommend that you take a proton pump inhibitor (PPI) or misoprostol to reduce your risk of an ulcer.

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/What-Causes-Heartburn-and-Indigestion

In order to help prepare you for a discussion with your doctor about your symptoms of indigestion or heartburn, here are some questions that your doctor might ask you. The better prepared you are, the better your doctor can tailor the treatment plan to you. Try having answers to these questions prepared ahead of time. It may be as simple as writing down the questions and your responses on a piece of paper or on your smartphone that you can show to your doctor at your appointment. You can even print off this page and use it as a template.

"Do you have difficulty or a dislike for swallowing pills?"

The treatment your doctor offers will only work to relieve your symptoms if it is taken as prescribed. Your doctor would like to prescribe a therapy that you will actually be able to take. So your doctor may ask if you have trouble swallowing tablets. Some therapies may involve taking fewer tablets than others and some medications may be available in dosage forms other than tablets that may be easier to take.

"Are you taking any prescription or over-the-counter painkillers on a regular basis? If yes, which one(s)?"

Nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate the stomach lining and interfere with the stomach's natural protective factors. This can lead to indigestion and sometimes ulcers. So if your doctor is assessing your symptoms of indigestion, he or she will request this information. Some of these medications are available without a prescription and some require a prescription. They are usually taken for pain relief.

"Do you sometimes forget to take your medication(s) as prescribed by your doctor?"

Many of the treatments prescribed for various conditions involving indigestion require that one or more medications be taken for several weeks or months. It will be important that you take the medication as prescribed so that it will work properly. So your doctor may wish to assess if you sometimes forget to take your medications. You and your doctor can then work together to find ways to make it easier to remember your medication.

"Would you be willing to make some lifestyle changes to help with your symptoms?"

Making some simple changes to your lifestyle can help manage your symptoms. Lifestyle changes that may help include:

• avoiding foods that make your symptoms worse
• decreasing the amount of fat in your diet
• eating smaller meals
• avoiding clothes that fit tightly around the waist
• raising the head of your bed
• not lying down after a meal
• quitting smoking

All material copyright MediResource Inc. 1996 – 2024. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/healthfeature/gethealthfeature/What-Causes-Heartburn-and-Indigestion