Patient information · Gastroenterology
Acid reflux and indigestion
what helps, and what needs looking into
Heartburn is common and usually harmless. What matters clinically is separating ordinary reflux from the small number of people whose symptoms need investigating — and recognising that chest pain from the heart is regularly mistaken for indigestion.
Call 999 if you have
- central chest pain or tightness lasting more than 15 minutes, particularly with sweating, nausea or breathlessness
- chest discomfort spreading to the jaw, neck, back or either arm
- vomiting blood, or vomit that looks like coffee grounds
- black, tarry stools
- sudden severe pain in the upper abdomen with a rigid, tender abdomen
Heart attacks are frequently mistaken for indigestion, and antacids sometimes appear to help, which is misleading. If in any doubt about chest pain, treat it as cardiac and call 999. In an emergency go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Arrange assessment promptly if you have
- difficulty swallowing, or food sticking
- unintentional weight loss
- persistent vomiting, or a feeling of fullness after small amounts
- new indigestion over the age of 55 that persists despite treatment
- a lump in the abdomen, or unexplained anaemia
What causes it
The valve between the gullet and stomach relaxes and stomach contents move upwards, irritating the lining. Common contributors are being overweight, smoking, alcohol, large or late meals, pregnancy, a hiatus hernia, stress, and certain medicines — anti-inflammatories, some blood pressure tablets, bisphosphonates and steroids among them.
What genuinely helps
Helps
- Eating smaller meals and not eating within three hours of bed
- Raising the head of the bed by 10–20cm, on blocks under the legs
- Losing weight if you are carrying extra, particularly around the middle
- Stopping smoking
- Keeping a diary of which foods reliably provoke it
Common triggers
- Alcohol, especially in the evening
- Coffee, chocolate, and fizzy drinks
- Fatty, fried or spicy food, tomatoes and citrus
- Tight waistbands, and bending or lying down after eating
- Anti-inflammatory painkillers such as ibuprofen
Extra pillows do not work
Piling up pillows bends you at the waist and increases pressure on the stomach, which can make reflux worse. What works is tilting the whole bed — blocks or risers under the legs at the head end, so you sleep on a slope rather than folded.
Medicines, and how to take them
- Antacids and alginates neutralise acid and form a raft on top of the stomach contents. Take them after meals and at bedtime rather than before — this is when they work.
- Proton pump inhibitors such as omeprazole or lansoprazole reduce acid production. Take them 30 to 60 minutes before breakfast, on an empty stomach. Taken with or after food they are considerably less effective, which is the usual reason people believe they are not working.
- A course is normally four to eight weeks, then a review. Long-term use is sometimes appropriate but should be a decision, not a drift.
- Do not stop a proton pump inhibitor abruptly after months of use — acid can rebound. Reduce it gradually with advice.
Testing
Helicobacter pylori is a bacterium that causes ulcers and indigestion, and it is easily detected on a breath or stool test and cleared with a short course of treatment. Testing is worthwhile in persistent indigestion. You need to be off proton pump inhibitors for two weeks before the test, or the result will be falsely negative.
Endoscopy — a camera test — is indicated where there are warning symptoms, where treatment has not worked, or where symptoms have persisted for years, to check the lining of the gullet and stomach.
Book an appointment if symptoms persist beyond a few weeks of treatment, you have any of the warning symptoms above, you have been on acid-reducing medicine for months without review, or you would like H. pylori testing or an endoscopy. We test on site and arrange gastroscopy through our CQC-registered partners without a wait.
H. pylori testing on site, endoscopy arranged fast
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.