Indigestion: What you should know

Pharmacist’s advice on prevention and heartburn remedies

Delightful festive feasts, after-dinner lounging and indulging in certain foods can sometimes invite an unwanted guest: indigestion. Ever wondered what’s behind that post-feast discomfort?

A pharmacist from Medipost, South Africa’s pioneering national courier pharmacy, has the answers.

“Indigestion, also called dyspepsia, refers to an uncomfortable pain in the stomach or chest that usually occurs after a person has been eating or drinking,” says pharmacist Heidi Zimmermann of Medipost Pharmacy.

“Other symptoms include sensations of fullness, bloating, nausea, burping and the unwelcome companion, heartburn – all tell-tale signs of reflux. This occurs when stomach acid escapes from your stomach into the oesophagus through the lower oesophageal sphincter [LES].”

The LES usually acts like a one-way valve, allowing food into the stomach and preventing the hydrochloric acid that digests our food from coming up the oesophagus and burning the lining, causing irritation, inflammation, pain and swelling.

Three common causes of indigestion are

• Having a large meal or drinking so much that the stomach is overfull and presses on the sphincter, forcing it open.
• Lying down after eating and drinking causes the stomach contents to push against the LES, and more acidic fluid can escape into the oesophagus.
• Certain foods trigger a chemical reaction, causing the LES to open. Methylxanthine in cocoa products, caffeine, alcohol and cigarette smoke are all known to have this effect, and peppermint, garlic and onions may also.

Prevention tips

• Eat a smaller supper, preferably at least three to four hours before going to bed
• Don’t drink liquids with meals
• Avoid caffeine, alcohol, cigarette smoke and other substances that may cause the LES to open
• Practise a healthy lifestyle with a balanced diet and regular exercise
• Try taking a magnesium supplement at night to help keep the LES closed

Antacids – fast-acting

“Antacids are available without prescription for immediate relief of indigestion and heartburn. Antacids containing minerals work by neutralising the hydrochloric acid. Alternatively, a teaspoon of sodium bicarbonate or baking soda dissolved in water is a common home remedy,” Zimmermann says.

Other antacids available from pharmacies include aluminium hydroxide, magnesium carbonate, magnesium trisilicate, magnesium hydroxide, and calcium bicarbonate.

“Antacids are usually safe to use, however, people with heart and renal disorders should take care not to have too much of these minerals. For example, elevated calcium levels can lead to heart rhythm disturbances, kidney stone formation, and potential harm to kidney function. Long-term overuse is more serious than a single overdose, although both should be avoided.”

To avoid interactions with other medications, separate the dosing of antacids and other medication by one to two hours. Consult your prescriber or pharmacist if you are unsure about medication interactions.

Proton pump inhibitors – acid reducing

“Proton pump inhibitors [PPIs], including medicines containing lansoprazole, pantoprazole, or omeprazole, are often recommended for treating acid reflux. PPIs work by reducing the acid produced in the stomach and are usually taken once a day 30 minutes before breakfast, or if taken twice daily, the second dose should be half an hour before supper.

“Bear in mind that PPIs take 24 hours to start working, and the full benefit is only realised about four days later, so think ahead if you are planning to indulge. Lower dosages of the PPIs and small quantities are available over the counter. If you are not finding relief or you suffer recurring indigestion, it is important to consult your doctor about the treatment plan that would work best for you.”

Zimmerman warns that PPIs should be used with caution in patients with severe hepatic disease, which is a serious condition affecting the liver. Pregnant women should avoid omeprazole and other medicines ending in ‘–prazole’ unless prescribed by a doctor who is aware of your pregnancy.

Histamine blockers – quick relief or prevention

Histamine blockers, often containing cimetidine, work by inhibiting hydrochloric acid production from the gastric glands in the stomach lining.

“Although less powerful than PPIs, histamine blockers start providing relief much sooner, in as little as 15 to 20 minutes. Histamine blockers may be taken one hour after an antacid to provide prolonged relief or as a preventative measure 30 minutes before eating or drinking,” Zimmermann says.

People who have had kidney or liver disease or are HIV positive should only take histamine blockers on the advice of their treating doctor. Histamine blockers are not advised for pregnant or breastfeeding mothers, and people who are on blood-thinning medication should take care because histamine blockers intensify bleeding.

“As a general rule, none of these medicines should be given without a prescription to children. Instead, speak to your pharmacist or healthcare provider about the available paediatric options,” she advises.

Short-term relief

If the symptoms of indigestion do not clear within two weeks of using self-medication, then it is time to consult a doctor to establish the root cause so that the right treatment can be prescribed for you.

“It is important to note that long-term use of any medicine that reduces stomach acidity compromises protein digestion, which may cause other digestive problems. In addition, side effects such as vitamin deficiencies also occur when these medications are used consistently for longer periods.

“Do not ignore the symptoms of indigestion because there are some potentially serious conditions such as heart disease, stomach ulcers, pleurisy and gallstones that can sometimes feel similar. Angina, or chest pain caused by lack of blood flow to the heart, for example, can feel a lot like heartburn. It is therefore, crucial to get a proper diagnosis,” Zimmermann says.