Medical advice

Should I see my doctor?

We know that indigestion is very common, and most people are able to take care of their symptoms by purchasing over-the-counter remedies from the pharmacist. However, it is worth seeking medical attention if you start getting these symptoms in middle age or later. Also, think about making an appointment if your indigestion does not settle with simple over-the-counter remedies (and there are a wide variety of medicines to try). If you are feeling generally unwell, losing weight or have any other reason to think that there is a serious problem with your health, then of course you should arrange to see your doctor. Any signs of possible internal bleeding mean that you should seek medical advice without delay.

Will I need tests?

There is no simple answer to this question. It was only a few years ago that many doctors thought that almost all patients with indigestion should have investigations at the hospital. This usually meant having an endoscopy examination which would involve you being asked to swallow a flexible tube to examine you internally. Over the past 10 years, guidance to doctors about how best to investigate patients with indigestion has changed several times. It is fair to say that, nowadays, it is not thought necessary to carry out an endoscopy on most people with indigestion. Unless you have symptoms that lead your doctor to have cause for concern, an endosocpy is rarely essential. Many individuals will be advised, in the first instance, to have some treatment
either to reduce the amount of acid that the stomach makes, or perhaps to clear Helicobacter pylori.

What might the doctor do if I have Helicobacter pylori?

There is good evidence that Helicobacter infection not only increases your chance of having a peptic ulcer, but possibly also causes you to have indigestion without necessarily having an ulcer. If you have indigestion, your doctor can check if you have Helicobacter infection either by doing a test on blood taken in the surgery or by a simple breath test. If the results are positive and suggest you have the infection, you are likely to be advised to take a one-week course of treatment with three separate drugs (triple therapy) which are often given without the need for any further investigation. However, if you are an older patient, or someone whose symptoms are persistent and respond badly to treatment, your doctor may recommend that you undergo further investigations.

What further tests might I need?

The most common investigation for those suffering with indigestion is an upper gastrointestinal endoscopy (known as gastroscopy for short) which is a day-case procedure in hospital. As technology improves, this procedure is becoming less and less uncomfortable. Although it is not especially pleasant, most people can tolerate just a few minutes of discomfort (the procedure is not painful) by having an anaesthetic spray to the throat. If you are apprehensive or feel you have a sensitive throat, there are alternatives to make the procedure less daunting. Endoscopy provides a great deal of information about your gullet, stomach and duodenum, and gives the specialist the opportunity to take samples of tissue to look for inflammation and infection.

What if I don’t want an endoscopy?

No one is going to insist that you have an endoscopy, although the procedure is much less unpleasant than it used to be. However, if you are unwilling to have an endoscopy for any reason, it may be reasonable to check whether you have Helicobacter infection and give you treatment if the result is positive. This is called ‘test-and-treat’. This way of helping patients with indigestion is proving increasingly attractive to GPs. Unless there is strong evidence that you have something quite seriously wrong, many of the causes of indigestion can also be controlled by taking tablets that reduce the amount of acid that is made in your stomach. A wide variety of medicines is available to your GP to cut down stomach acid. Your doctor will advise which is most appropriate for you.