Dyspepsia

The symptoms often come on shortly after eating or drinking, and may be aggravated by bending forwards or lying down:

• Heartburn – a painful burning feeling in the chest
• Pain in the upper abdomen
• Feeling full and bloated
• Feeling sick
• Belching
• Bringing up food or bitter tasting fluid
• Persistent cough, especially at night
• Sore throat
• Bad breath

If you have any of the following alert symptoms, then it is important to seek urgent advice from your GP or by phoning 111:

• Persistent/worsening symptoms (especially if you have had Barrett’s oesophagus, atrophic gastritis or intestinal metaplasia or dysplasia diagnosed at previous endoscopy or if you had peptic ulcer surgery more than 20 years ago)
• Severe pain
• Are 55 years old or older with symptoms for the first time
• Unintentional weight loss
• Difficulty swallowing
• Vomiting recurrently
• Feel like you have a lump in your stomach
• Bloody vomit or poo (partially digested blood is dark brown or black creating “coffee ground” vomit or tarry black stools known as “melaena”)

These symptoms could be a sign of something more serious.

The stomach contains acid (“gastric acid”) to help with digestion but normally the stomach lining is protected by a special coating of mucus. Sometimes this coating fails, allowing the acid to aggravate the stomach lining. This may cause inflammation (“gastritis”) or even ulceration.

The muscles between the gullet (oesophagus) and the top of the stomach normally create a pinch valve to stop gastric acid from splashing back into the gullet (for example when you are lying flat or stooping forwards). This valve can become lax and leak or become adversely affected by the presence of a hiatus hernia (where a part of the stomach rises above the diaphragm into the chest) . When this happens, gastric acid can reflux and cause inflammation in the lower part of the gullet. This is known as gastro-oesophageal reflux disease or GORD.

Other things that may cause dyspepsia include:

• Medicines
• Smoking
• Alcohol
• Pregnancy

Stress can also make dyspepsia worse.

Most cases of recurring dyspepsia are due to one of the following:

• Acid reflux, oesophagitis and GORD (Gastro-oesophageal reflux disease)
• Hiatus hernia
• Duodenitis and gastritis
• Duodenal and stomach ulcers
• Non-ulcer dyspepsia

The germ Helicobacter pylori (H. pylori) can infect the lining in the stomach and duodenum. It is one of the most common infections in the UK and most people have no symptoms and do not know they are infected. H. pylori is the most frequent cause of duodenal and stomach ulcers. You can have a test to detect H. pylori if you are having numerous bouts of dyspepsia.

In most cases you can manage the symptoms of Dyspepsia yourself at home by making lifestyle changes. You can also discuss with a pharmacist about treatments you can buy without needing a prescription.

Lifestyle changes to help Dyspepsia

You can avoid triggers that may make reflux worse:

• Stop smoking if you are a smoker
• Reduce or stop drinking alcohol
• Reduce or stop drinking coffee
• Reduce or stop eating chocolate, fatty foods and other foods that make your symptoms worse
• Eat smaller meals and avoid eating within 3-4 hours of bedtime
• Lose weight if you are overweight or obese
• Raise the head of your bed so stomach acid is less likely to travel up towards your throat
• Do not wear clothes that are tight around your waist

You can obtain advice from a pharmacist about medications you can buy without prescription. Your pharmacist will want to ask you about your health problems and other medication you are taking to be sure the treatments recommended are suitable for you. Find a pharmacy here.

These medications include antacids and antacids with alginates. The antacid helps to neutralise acid in your stomach and the alginate forms a layer on top of the liquid in your stomach, so helping to reduce your symptoms. These medications usually work better in liquid than tablet form, although of course tablets are much easier to carry around.

You can also buy small numbers of medications that are like those that your doctor can prescribe (proton pump inhibitors). These help by reducing the amount of acid that is made by your stomach.

Your pharmacist can also discuss whether any medications you are buying for other conditions might be making your reflux worse. An example is non-steroidal anti-inflammatory drugs such as ibuprofen. It is possible that the pharmacist could recommend an alternative which would not cause the symptoms.

If you have alert symptoms mentioned above, then you should arrange to get urgent medical advice.

Otherwise, if lifestyle changes and over the counter pharmacy medications are not helping, you should seek medical advice by contacting your GP. Your GP will probably go through the lifestyle measures you have already taken. They will also review your prescription medications to see if any of those might be contributing to the problem and to consider alternatives.

Your GP can prescribe further medications to help reduce the amount of acid your stomach is producing. They may carry out some tests to help rule out other problems.

If your symptoms are severe or if medications do not help, then your GP may refer you for tests by a specialist. This could include a gastroscopy, where a thin tube with a camera is passed down your throat to find out what’s causing your symptoms.

Although a gastroscopy is usually a simple test, like all investigations it can occasionally result in complications. For this reason, it is important to be sure that all the other less invasive options are considered first as most people will improve and not require a gastroscopy.

In Devon, in order to help ensure that gastroscopy is only carried out on appropriate patients, your GP must include in the referral letter details of the steps that you have taken and the tests that have already been carried out. Unless there are alert symptoms, the referral will only be accepted if you have already tried to resolve the problem by taking the recommended lifestyle measures and trying medication.