Patients often come into the pharmacy with indigestion, so it's worth having some go-to tips at hand to treat the symptoms ...and find the causes.
1. Ask patients to describe their symptoms
When patients come to you with symptoms of indigestion, ask them to describe exactly what these are.
A typical symptom of indigestion is heartburn, which is a burning feeling behind the breast bone.
Patients who have indigestion may also have other symptoms, such as: feeling uncomfortably full or heavy; belching; flatulence; bringing food or fluid back up from the stomach (acid reflux); bloating; nausea; or vomiting.
2. Try to identify ‘triggers’...
Common indigestion triggers can include smoking – which is a major cause of heartburn, as it increases stomach acid.
In some people, eating a large meal can result in indigestion, as can rich or spicy foods, acidic or caffeinated drinks, and alcohol.
Some medications, such as theophylline and non-steroidal anti-inflammatory drugs (NSAIDs), can also cause indigestion. While they are not direct triggers, stress and anxiety can also contribute to symptoms of indigestion.
3. ...and suggest ways to remove triggers
Having established what the triggers are, look at what you can do to help patients to reduce them. This could involve encouraging patients to give up smoking, or advising them to avoid large meals or foods that trigger indigestion.
4. Consider different treatment options
There are three main options available for indigestion symptoms:
- Antacids, such as sodium bicarbonate, neutralise acids in the stomach. They can offer rapid relief, but can also cause acid reflux – which makes the problem worse. Gaviscon contains an antacid and an alginate, which forms a protective layer over the stomach contents. This can provide immediate relief for someone experiencing heartburn.
- H2 receptor antagonists, commonly known as H2 blockers, reduce the amount of acid produced by the cells in the lining of the stomach. These drugs, for example ranitidine, are used to both prevent and relieve heartburn.
- Proton pump inhibitors (PPIs), such as Nexium, reduce the amount of acid made by the stomach. They are commonly used to treat acid reflux, as well as ulcers of the stomach and the duodenum (part of the gut). PPIs can also be used for heartburn, but they do not provide immediate relief of indigestion symptoms – it may take up to three days for these medicines to have their full effect.
5. Look out for 'red flags'
Indigestion can sometimes be indicative of other problems, such as heart conditions or some cancers. For example, you should refer patients to their GP if they have any of the symptoms mentioned above as well as one of the following:
- Recent, unexplained weight loss
- Persistent vomiting
- Are 55 years or older and have indigestion for the first time.
Terry Maguire is owner of Maguire Pharmacy, and a community pharmacist in Northern Ireland