Heartburn And Indigestion

By : Ms Lim Wen Chean, Pharmacist at Unity Tiong Bahru Plaza

First seen in Lifestyle Magazine (June 2014), pg 123. This article is an unbreached version of the print edition.

Introduction

You have just finished devouring a plate of delicious “char kway teow” and downed a glass of ice-cold “kopi ping” for lunch but your stomach is feeling uncomfortable and far from satisfied. You feel a general discomfort in your stomach, bloated, nauseated and they are slowly turning into digestive pain. So, what exactly are you experiencing? Is it indigestion or heartburn?

Symptoms

Indigestion, medically known as dyspepsia, affects the lining of the stomach. The primary symptom of indigestion is a general discomfort in the upper abdomen under the breast bone. Other symptoms include burping, bloating, nausea, early satiety (fullness) and may be accompanied by heartburn.

Heartburn is a burning sensation that usually arises from the lower chest area and moves up towards the neck or throat. This burning sensation occurs when the acid in the stomach escapes or regurgitates back into the esophagus. Most people experience “simple” heartburn, which is typically mild, infrequent, episodic and often associated with diet or lifestyle while others have frequent heartburn (two or more days in a week). Heartburn has nothing to do with the heart although the discomfort of heartburn may be confused with heart pain. Indigestion is a medical condition and heartburn is considered a symptom of indigestion.

Causes

Diet and lifestyle are the most common causes of heartburn and indigestion. Fatty food, spicy food, chocolates, mints, alcohol, caffeinated beverages, carbonated beverages and citrus fruits or juices are the common culprits of heartburn and indigestion. Overeating, eating too fast, lying down immediately after eating, cigarette smoking, stress and fatigue are some of the lifestyle risk factors and causes. Other causes include diseases such as stomach ulcers, stomach infections and irritable bowel syndrome, and medications such as aspirin, painkillers and steroids.

Treatments

Treatment of heartburn and indigestion typically comprises of lifestyle modifications and self-medications. However, it is important to recognize signs and symptoms that may warrant a visit to the doctor. These signs and symptoms include:

  • Frequent heartburn for more than three months
  • Severe heartburn and indigestion
  • Difficulty or pain on swallowing solid food
  • Vomiting up blood
  • Black tarry stools
  • Unexplained weight loss
  • Chronic hoarseness, wheezing, coughing or choking
  • Continuous nausea, vomiting or diarrhea
  • Chest pain accompanied by sweating, pain radiating to shoulder, arm, neck or jaw, and shortness of breath
  • Persistence of heartburn and indigestion symptoms during or after two weeks of self-treatment
  • Pregnancy
  • Nursing mothers
  • Children younger than 12 years old

Once exclusions for self-treatment have been ruled out, over-the-counter medications are available for symptomatic relief. The first-line treatment of choice for mild heartburn and indigestion is antacids which are fast in relieving symptoms. For moderate or frequent heartburn and indigestion symptoms, histamine-2-receptor antagonists (such as famotidine) and proton pump inhibitors (such as omeprazole) which are only available through a pharmacist can provide a longer duration of action compared to antacids.

Besides relying on medications, lifestyle and dietary modifications can help in reducing risks and recurrences of heartburn and indigestion episodes. Here are some useful tips on lifestyle and dietary modifications:

  • Avoid food and beverages that are known to trigger symptoms.
  • Avoid eating large meals. Eat smaller, more frequent meals instead and eat slowly.
  • Avoid talking while you eat and close your mouth when you chew to reduce the amount of air that you swallow with your food. This can help to reduce bloating.
  • Do not lie down for about two hours after meals.
  • Elevate your head a few inches while you sleep.
  • Stop or reduce smoking and alcohol.
  • Avoid use of medications that may aggravate symptoms (e.g. aspirin, NSAIDs).
  • Lose weight if you are overweight by exercising at least 150 minutes a week and having a healthy diet.
  • Wear loose-fitting clothing. Do not wear belts or clothes that are tight fitting around the waist.
  • Allow yourself to relax to alleviate stress.
If symptoms persist or worsen after 14 days of effective self-treatment, a doctor should be consulted.

Conclusion

By practicing lifestyle and dietary modifications, and also simple self-medication, symptoms of heartburn and indigestion can be prevented and/or alleviated, allowing for better enjoyment of meals.

References:

  1. Handbook of Nonprescription Drugs
  2. NHS Choices (www.nhs.uk)