Indigestion - Treatment

Treatment for indigestion (dyspepsia) will vary depending on what is causing it and how severe your symptoms are.
If you have been diagnosed with an underlying health condition, you may want to read our information on treating gastro-oesophageal reflux disease (GORD) and treating a peptic ulcer.

Diet and lifestyle changes

If you have indigestion only occasionally with mild pain and discomfort, you may not need to see your GP for treatment. It may be possible to ease your symptoms by making a few simple changes to your diet and lifestyle, summarised below.

Healthy weight

Being overweight puts more pressure on your stomach, making it easier for stomach acid to be pushed back up into your oesophagus (gullet). This is known as acid reflux, and is one of the most common causes of indigestion.
If you are overweight or obese, it is important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet. Read advice on losing weight.


Stop smoking

If you smoke, the chemicals you inhale in cigarette smoke may contribute to your indigestion. These chemicals can cause the ring of muscle that separates your oesophagus (gullet) from your stomach to relax. This allows stomach acid to leak back up into your oesophagus more easily (acid reflux).
Read more about quitting smoking and speak to your GP or pharmacist. You can also call the NHS Smoking Helpline on 0800 022 4332.

Diet and alcohol

Make a note of any particular food or drink that seems to make your indigestion worse and avoid these if possible. This may mean:

• eating less rich, spicy and fatty foods
• cutting down on drinks that contain caffeine, such as tea, coffee and cola
• avoiding or cutting down on alcohol

At bedtime

If you tend to experience indigestion symptoms at night, avoid eating for three to four hours before you go to bed. Going to bed with a full stomach means there is an increased risk that acid in your stomach will be forced up into your oesophagus while you are lying down.

When you go to bed, use a couple of pillows to prop your head and shoulders up, or raise the head of your bed by a few inches by putting something underneath the mattress. The slight slope that is created should help to prevent stomach acid moving up into your oesophagus while you are asleep.

Changing current medication

Your GP may recommend making changes to your current medication if they think it could be contributing to your indigestion.

As long as it is safe to do so, you may need to stop taking certain medications, such as aspirin or ibuprofen. Where possible, your GP will prescribe an alternative medication that will not cause indigestion. However, never stop taking any medication without consulting your GP first.

Immediate indigestion relief

If you have indigestion that requires immediate relief, your GP can advise you about the best way to treat this. As well as lifestyle changes and reviewing your current medication, your GP may prescribe or recommend:

• antacid medicines
• alginates

These are described in more detail below.

Antacids

Antacids are a type of medicine that can provide immediate relief for mild to moderate symptoms of indigestion. They work by neutralising the acid in your stomach (making it less acidic), so that it no longer irritates the lining of your digestive system.

Antacids are available in tablet and liquid form. You can buy them over the counter from most pharmacies without a prescription.

The effect of an antacid only lasts for a few hours at a time, so you may need to take more than one dose. Always follow the instructions on the packet to ensure you do not take too much.

It is best to take antacids when you are expecting symptoms of indigestion or when they start to occur, such as:

• after meals
• at bedtime

This is because antacids stay in your stomach for longer at these times and have more time to work. For example, if you take an antacid at the same time as eating a meal, it can work for up to three hours. In comparison, if you take an antacid on an empty stomach, it may only work for 20 to 60 minutes.

Read more about antacids, including possible interactions with other medicines and side effects.

Alginates

Some antacids also contain a medicine called an alginate. This helps relieve indigestion caused by acid reflux.

Acid reflux occurs when stomach acid leaks back up into your oesophagus and irritates its lining. Alginates form a foam barrier that floats on the surface of your stomach contents, keeping stomach acid in your stomach and away from your oesophagus.

Your GP may suggest that you take an antacid that contains an alginate if you experience symptoms of acid reflux or if you have gastro-oesophageal reflux disease (GORD).

Take antacids containing alginates after eating, because this helps the medicine stay in your stomach for longer. If you take alginates on an empty stomach, they will leave your stomach too quickly to be effective.

Treating persistent indigestion

If you have indigestion that is persistent or recurring, treatment with antacids and alginates may not be effective enough to control your symptoms. Your GP may prescribe a different type of medication, which will be prescribed at the lowest possible dose to control your symptoms. Possible medications include:

• proton pump inhibitors
• H2-receptor antagonists
• prokinetics

These are described in more detail below. Your GP may also test you for the Helicobacter pylori (H pylori) bacteria (see Indigestion - diagnosis) and prescribe treatment for this if necessary.

Proton pump inhibitors (PPIs)

PPIs inhibit the acid produced in your stomach.

The medication is taken as tablets and is generally only available with a prescription. If you are over 18, you can buy some types of PPIs over the counter in pharmacies, but these should only be used for short-term treatment. If your ingestion is persistent, see your GP.

PPIs may enhance the effect of certain medicines. If you are prescribed a PPI your progress will be monitored if you are also taking other medicines such as:

• warfarin, a medicine that stops the blood clotting
• phenytoin, a medicine to treat epilepsy

If your GP refers you for an endoscopy (a procedure that allows a surgeon to see inside your abdomen), you will need to stop taking a PPI at least 14 days before the procedure. This is because PPIs can hide some of the problems that would otherwise be spotted during the endoscopy.

In some cases, PPIs can cause side effects. However, they are usually mild and reversible. These side effects may include:

• headaches
• diarrhoea
• constipation
• nausea (feeling sick)
• vomiting
• flatulence (wind)
• stomach pain
• dizziness
• skin rashes

H2-receptor antagonists

H2-receptor antagonists are another type of medication that your GP may suggest if antacids, alginates and PPIs have not been effective in controlling your indigestion. There are four H2-receptor antagonists:

• cimetidine 
• famotidine 
• nizatidine 
• ranitidine 

These medicines work by lowering the acidity level in your stomach. Click on the above links for more information on these drugs.

Your GP may prescribe any one of these four H2-receptor antagonists, although famotidine and ranitidine are available to buy over the counter in pharmacies. H2-receptor antagonists are taken either in tablet or liquid form.

As with PPIs, you will need to stop taking H2-receptor antagonists at least 14 days before having an endoscopy. This is because they can hide some of the problems that could otherwise be spotted during the endoscopy.

Prokinetics

If you are still experiencing symptoms of indigestion after taking antacids, alginates and PPIs, your GP may suggest a medicine known as a prokinetic.

There are two types of prokinetics available:

• domperidone 
• metoclopramide 

Click on the above links for more information on these medicines.

Domperidone and metoclopramide help food pass through your stomach and the first part of your small intestine (duodenum) more quickly, so indigestion is less likely to occur.

You may be prescribed domperidone by your GP, although it is also available over the counter in pharmacies for people aged 16 or over.

Metoclopramide is only available on prescription from your GP. Both medicines can be taken in tablet or liquid form.

If you are prescribed domperidone, you will need to take it 15 to 30 minutes before a meal so it has time to work before your symptoms of indigestion start.

Helicobacter pylori (H pylori) infection

If your indigestion symptoms are caused by an infection with H pylori bacteria, you will need to have treatment to clear the infection from your stomach. This should help relieve your indigestion because the H pylori bacteria will no longer be increasing the amount of acid in your stomach.

H pylori infection is usually treated using triple therapy (treatment with three different medications). Your GP will prescribe a course of treatment containing:

• two different antibiotics (medicines to treat infections that are caused by bacteria)
• a PPI

You will need to take these medicines twice a day for seven days. You must follow the dosage instructions closely to ensure that the triple therapy is effective.

In up to 85% of cases, one course of triple therapy is effective in clearing an H pylori infection. However, you may need to have more than one course of treatment if it does not clear the infection the first time.

12 Ways to Improve Back Pain

By Carolyn Sayre
WebMD Feature


Like the nearly 80% of Americans who will experience a back problem during their lifetime, Beverly Hayes suffers from back pain. For many, the injury is triggered by a strenuous activity, like gardening or weight lifting. Others simply bend down to pick up a pencil and their back gives out.

“It felt like a screwdriver was piercing through by bones,” the 46-year-old Chicago artist says about the pain that developed shortly after she ran a half-marathon. “It took over my life. I couldn’t bend down or sleep — I was petrified I would never feel normal again.”  


Mary Ann Wilmarth PT, DPT, OCS, a spokeswoman for the American Physical Therapy Association and chief of physical therapy at Harvard University, says it is critical that people address any back pain or injury right away. “Early intervention can help prevent a chronic problem from developing and obviate the need for medication and surgery,” she says.

Thanks to a combination of activity, core strengthening exercises, and physical therapy, Hayes says her symptoms have improved dramatically over the last year. Here are 12 ways to help alleviate back pain:

1. Limit Bed Rest

It may seem counterintuitive, but studies show that people with acute low-back pain who rest have more pain and are less able to perform daily tasks than those who stay active.

“Patients should avoid more than three days of bed rest,” says Mike Flippin, MD, an orthopaedic surgeon who specializes in back and spine care at San Diego Medical Center. “I encourage my patients to get moving as quickly as possible.”


2. Keep Exercising

Activity is often the best medicine for back pain. “Simple exercises like walking can be very helpful,” Wilmarth says. “It gets people out of a sitting posture and puts the body in a neutral, upright position.”

But remember to move in moderation, Flippin says. “Stay away from strenuous activities like gardening and avoid whatever motion caused the pain in the first place.”

3. Maintain Good Posture

The pain may have started after a long workout at the gym, but the strain that caused it has probably been building for years. Wilmarth says most people perform their daily activities with poor posture, putting unnecessary strain on their back.

“Little things add up,” she says. “You can increase the pressure on your back by 50% simply by leaning over the sink incorrectly to brush your teeth. Keeping the right amount of curvature in the back takes pressure off the nerves and will reduce back pain.”

4. See a Specialist

Developing an individualized exercise plan is essential to managing chronic back pain, says D. Scott Davis, PT, MS, EdD, OCS, an orthopaedic physical therapist and associate professor at West Virginia University.

“There is no magic aspirin that addresses lower back pain in everyone,” Davis says. “Some patients need more core strengthening while others benefit mainly from stretching and improving flexibility. Find a physical therapist, exercise physiologist, or chiropractor who specializes in back care. They will match you with the right exercise plan.”


5. Strengthen Your Core

Most people with chronic back pain would benefit from stronger abdominal muscles.

“The torso is a combination of many muscle groups working together,” Frank B. Wyatt, EdD, professor of exercise physiology at Missouri Western State University, tells WebMD in an email. “If the abdominals are weak, other areas must pick up the slack. When we strengthen the abdominals, it often reduces the strain on the lower back.”

6. Improve Flexibility

Too much tension and tightness can cause back pain. "Our goal in increasing flexibility is to put an equal load throughout the body from the feet all the way up to the head,” Davis says. “One good exercise is to sit on the edge of the bed with one leg extended and the other one on the floor. Give your hamstrings a stretch by leaning forward while keeping your back in a neutral position.”

7. Ditch the Brace

It’s tempting to baby your back muscles, but Davis says braces should be used sparingly. “Braces are helpful for strenuous activities, like heavy lifting, but only keep them on for 15 minutes at a time,” he says. “If you wear a brace all day, the muscles — which should be providing stability — atrophy and you will have less core strength.”

8. Apply Ice and Heat

Heating pads and cold packs can comfort tender trunks. Most doctors recommend using ice for the first 48 hours after an acute injury -- particularly if there is swelling — and then switching to heat.

But "it is difficult to say if ice or heat is more beneficial,” Flippin says. “I recommend that patients use whichever they find comforting as long as their skin is protected.”

9. Sleep the Right Way

The amount of rest you get is important, and so is the position you get it in. “Sleeping in a bad position or on a mattress without support can cause back pain,” Wilmarth says.


10. Quit Smoking

Lighting up doesn’t just damage your lungs; it can also hurt your back.

A study recently published in the American Journal of Medicine found that current and former smokers are more likely to have back pain when compared with people who have never smoked. 

“Nicotine causes the small blood vessels to constrict and decreases the delivery of blood to the soft tissue,” Flippin says. “I tell all my patients that quitting smoking could help alleviate their back pain.”

11. Try Talk Therapy

Back pain is often associated with underlying psychological issues such as depression and anxiety, says Alex Moroz, MD, associate professor of rehabilitation medicine at NYU Langone Medical Center.

“Your emotional state colors the perception of pain,” Moroz says. “Therapy can be a helpful part of rehabilitation.”


12. Use Relaxation Techniques

Research shows that practices such as meditation, deep breathing, tai chi, and yoga, which help put the mind at rest, can do wonders for the back.

“If you can induce a relaxation response, it will help reduce the perceived pain level," Moroz says.

6 Natural Cures for Dry Skin

By AMY AHLBERG
Rodale.com


Parched lips, flaky skin and flyaway, staticky hair -- we can thank winter's lower humidity, and the central heating, space heaters and fireplaces we use to counteract it, for a whole host of cold-weather beauty woes.

To keep your skin and hair from bumming you out all winter, try these natural skin care treatments from Ilona Pecnikov, director of esthetics at the New York City spa Just Calm Down, and Julie Gabriel, owner of skin care line Petite Marie Organics and author of The Green Beauty Guide: Your Essential Resource to Organic and Natural Skincare, Hair Care, Makeup and Fragrances (HCI, 2008). You'll be soft and silky in no time.

Dab on Olive Oil

When it comes to strategies for natural dry skin care, Gabriel swears by olive oil, an amazing multitasker. It instantly grooms dry cuticles, works wonders on hands and elbows, removes makeup, and soothes and conditions itchy, dry skin all over the body. "When your skin feels extra parched, you can dab a thin layer of organic extra-virgin olive oil under your moisturizer for an extra dose of antioxidants and good fatty acids," adds Gabriel.

The Truth About Natural Foods

Exfoliate With Yogurt, Papaya or Pumpkin

You can find plenty of options for natural dry skin care in your kitchen, or in the produce and diary aisles of your supermarket. Yogurt, especially the plain Greek variety, makes an excellent cleanser with a mild exfoliating action that will remove dry skin and leave you feeling refreshed and comfortable. Gabriel says it's a particularly safe exfoliant for very dry skin because it exfoliates using lactic acid, not scrubbing granules.

To add some oomph, try making Pecnikov's Greek Yogurt and Papaya Enzyme Conditioning Mask for Face & Décolleté: Mix ½ cup of Greek yogurt with 3 tablespoons of mashed-up papaya, and apply to skin.


Pumpkin enzymes are at play in her Pumpkin & Cinnamon Mask for Face and Body: mix one can of pumpkin and a ½ teaspoon of cinnamon powder.

Leave either mask on face or body for 5 to 15 minutes.

Or treat your extremities to her Three Berry Antioxidant Hand and Foot Mask: Mix 3/4 cup each of strawberries, raspberries, and blueberries with ½ cup kefir in blender. Drink any leftovers!

Make a Homemade Skin Scrub

Economical and effective, a combo of sugar and any oil you may have around the kitchen makes a rich, nourishing body scrub for dry skin, according to Gabriel.

Simply mix equal amounts of fine brown sugar and oil, and rub on using light circular motions.

For an extra dose of vitamins and minerals, add a tablespoon of honey. Pecnikov adds lemon juice to her recipe.

Make sure to shower thoroughly afterwards!

Harvest the Healing Power of Honey

Honey is a time-tested cure for chapped, cracked lips, according to Gabriel.

Apply a little organic honey in the evening and wake up to smooth, yummy lips. This trick also works to soothe cracked heels and rough elbows.