Indigestion and heartburn

by | Gastrointestinal Health, Pharmacy Care, Symptoms

General Information

Indigestion (dyspepsia) is the term used to describe pain or discomfort after eating, although it can also occur on an empty stomach. Indigestion has many causes, including overeating, eating spicy or fatty foods, some medicines and stomach ulcers. Very rarely, it can be a symptom of stomach cancer.
Heartburn (stomach acid reflux) is a common feature of indigestion. Heartburn happens when the acid contents from your stomach escape back up into your oesophagus (gullet). This causes a burning sensation behind your breastbone, rising up towards your throat. It often happens after eating, exercising or lying down, and is more common during pregnancy because the stomach is pushed upwards by the baby. If heartburn happens regularly it is referred to gastro-oesophageal reflux disease.
Other common symptoms of indigestion include excess gas or wind, and feeling bloated.
Indigestion is more common in people who are overweight, smoke or have a stressful lifestyle, and can be frequent in pregnant women.

See Your Pharmacist or Medical Professional

  • if you think the pain might be from your heart, i.e. if it radiates through your jaw, neck, shoulders or arm and/or it gets worse when you exert yourself; seek professional medical help immediately
  • if you have severe abdominal pain
  • if your bowel motions are tarry and black
  • if you have unexplained weight loss
  • if you have heartburn regularly, or if it is happening more often than before
  • if you need to use antacids more than three or four times a week, or for more than two weeks in a row
  • if you have taken other heartburn medication (such as ranitidine or pantoprazole) for two weeks with inadequate relief of symptoms
  • if you have difficulty or pain when you swallow, or choking when you sleep
  • if you also have bouts of coughing
  • if you are vomiting, especially if it is blood-stained (either fresh red or looks like brown ‘coffee grounds’)
  • if there is a family history of gastrointestinal cancer
  • if the person is over 40 or under 12 years old
  • if you are taking other medication, especially aspirin or anti-inflammatories, e.g. ibuprofen

Treatment Tips

  • avoid foods you know cause you indigestion problems (such as fatty and spicy foods)
  • eat smaller meals more often
  • reduce caffeine intake
  • reduce your alcohol intake
  • avoid wearing tight belts
  • try to keep your bodyweight in the healthy range
  • stop smoking
  • avoid bending over or lying down after a meal to help prevent your stomach contents being pushed upwards and causing heartburn
  • if you have heartburn at night, try sleeping with your upper body in a more propped up position, and avoid eating for two hours before bedtime
  • always swallow medicines with a glass of water, unless advised otherwise

Treatment Options

Acid neutralisers (antacids)

e.g. aluminium + magnesium + simethicone (Gelusil, Mylanta Double Strength, Mylanta Original), aluminium + magnesium (Gastrogel), calcium carbonate (Andrews TUMS, Titralac, Quick-Eze), calcium + magnesium (Mylanta Rolltabs, Rennie Spearmint Flavour), sodium + citric acid andhydrous (Eno Fruit Salt)

  • most antacids contain magnesium and/or aluminium and/or calcium; they work by neutralising stomach acid
  • magnesium antacids may cause diarrhoea
  • aluminium and calcium antacids may cause constipation
  • some antacids contain aluminium and magnesium to try and reduce any effect on the bowels
  • antacids may reduce the absorption of some medicines and need to be taken two hours apart from them; check with your pharmacist
  • products with a high sodium content, such as effervescent tablets containing sodium bicarbonate, should be avoided by people with heart disease, high blood pressure and in pregnancy
  • some antacids may not be suitable for people with kidney disease

Barrier medicines (alginates)

e.g. Gaviscon range, Mylanta Heartburn Relief

  • alginates form a ‘raft’ above your stomach contents, either preventing them being regurgitated up towards your throat, or if the contents are regurgitated, reducing the ‘acid burn’ as it rises from your stomach
  • these are used for quick relief of occasional heartburn
  • these barrier medicines also contain acid neutralisers
  • they are used in combination with magnesium, sodium, calcium and aluminium salts
  • they may not be suitable for people with heart or kidney conditions; check with your pharmacist

Reducers of stomach acid secretion

Histamine H2 receptor blockers

  • these medicines reduce the amount of acid in the stomach
  • these are used to relieve occasional reflux symptoms

e.g. ranitidine 150 mg, packets of 14 tablets (Gavilast 12 Hour Action Tablets, Mylanta Ranitidine 12 Hour Action, Zantac Relief)
e.g. ranitidine 150 mg, packets of 28 tablets (Gavilast 12 Hour Action Tablets, Mylanta Ranitidine 12 Hour Action, Zantac Relief), ranitidine 300 mg, packets of 14 tablets (Zantac Relief Extra Strength, Ranital Forte)
e.g. famotidine (Ausfam, Pamacid), nizatidine (Nizac, Tacidine, Tazac), ranitidine (Ausran, Zantac, Rani 2, Ranital), cimetidine (Magicul)

Proton pump inhibitors

  • these medicines reduce the amount of acid in the stomach
  • these are used when you have frequent symptoms of reflux

e.g. esomeprazole (Nexium 24HR, Noxicid, Mepreze 7 pack), pantoprazole (Somac Heartburn Relief 7 pack, Salpraz), rabeprazole (Pariet 10 7 Pack)
e.g. pantoprazole (Somac Heartburn Relief 14 pack, Salpraz), rabeprazole (Pariet 10 14 pack), esomeprazole (Nexium 24HR, Noxicid, Mepreze 14 pack)

  • histamine H2 receptor blockers and PPIs are effective for short-term relief and prevention of indigestion and heartburn, and work by reducing the amount of acid produced by your stomach
  • they should be taken long-term only when prescribed by a doctor. If symptoms persist after a two week course, seek medical advice

e.g. omeprazole (Acimax Tablets, Losec Tablets, Omepral Tablets, Maxor Capsules, Ozmep Tablets, Pemzo Capsules, Probitor Capsules), esomeprazole (Nexium, Noxicid, Nexazole Tablets, Nexole Tablets), pantoprazole (Somac Tablets and Granules, Gastenz Tablets, I-Pantoprazole, Ozpan Tablets, Panthron Tablets, Panto Tablets, Salpraz Tablets, Sozol Tablets, Topra Tablets, Torzole Tablets), lansoprazole (Zoton FasTabs, Lanzopran Capsules, Zopral ODT), rabeprazole (Pariet, Zabep 20, Parbezol Tablets, Prabez Tablets, Razit Tablets)

  • these medicines are very effective in the treatment of acid reflux and stomach ulcers
  • larger quantities (more than 14 tablets/capsules), granules and ODT are only available on prescription.

Anti-flatulence (anti-wind) agents

e.g. simethicone (DeGas Capsules, Mylanta Original, Mylanta Double Strength, Mylanta P Suspension, Gasbusters Capsules)

  • simethicone is included in some antacids
  • it helps to reduce flatulence (wind) and bloating by dispersing trapped gas

Other products

e.g. peppermint (Mintec)

  • peppermint oil is a traditional remedy for indigestion and many people find it very effective
  • it may make heartburn worse
  • it is important not to break or chew the capsules to avoid throat irritation
  • it should not be taken by children or during pregnancy unless recommended by a doctor
  • it is best to take these capsules 30 minutes before eating, but not immediately after food or with hot drinks

e.g. combination herbal ingredients (Iberogast oral liquid)

  • beneficial for many digestive issues including stomach pain, abdominal cramps, bloating, gas, heartburn, diarrhoea, fullness, nausea, and constipation
  • can be taken up to 3 times per day, mixed into a liquid of your choice, before or with meals.

More Information

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.
  • PRESCRIPTION ONLY MEDICINE available only with a doctor’s prescription.

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