Health Matters | Advice from your community pharmacist
That burning feeling rising from your stomach towards your throat after a meal is familiar to many people. Perhaps it happens after a spicy curry, a plate of nasi lemak, a late-night supper or simply when you lie down to sleep. You may reach for an antacid and carry on with your day.
Occasional heartburn is common. But when it keeps returning, disturbs your sleep or leaves you relying on indigestion remedies day after day, it is worth understanding what is happening — and whether something more needs to be done.
As a community pharmacist, I often find that people use the terms heartburn, acid reflux, GORD and indigestion as though they mean exactly the same thing. They are related, but there are differences.
What is the difference between heartburn, reflux and indigestion?
Heartburn is a burning sensation behind the breastbone, often travelling upwards towards the throat. Despite its name, it is not usually a problem with the heart itself. It commonly happens when stomach contents flow backwards into the oesophagus — the tube connecting your mouth to your stomach.
Acid reflux describes that backward movement of stomach contents. You might notice a sour or bitter taste in your mouth, or food and fluid coming back up after eating. Symptoms are often worse after a large meal, when bending over or when lying down.
When reflux happens frequently and causes troublesome symptoms or complications, it may be called gastro-oesophageal reflux disease (GORD). In the United States, the same condition is commonly called GERD.
Indigestion, also known as dyspepsia, is a broader term for discomfort in the upper abdomen. It can cause bloating, belching, nausea, feeling uncomfortably full after eating or burning and discomfort around the stomach. It may occur alongside heartburn, but the two are not identical.
The NHS guide to heartburn and acid reflux and its indigestion guidance explain these symptoms in more detail.
Why does acid come back up?
Normally, a ring of muscle at the lower end of the oesophagus helps prevent stomach contents from travelling upwards. If this barrier relaxes at the wrong time or does not work effectively, reflux can occur.
Certain habits and circumstances can make symptoms worse. Large meals stretch the stomach, while fatty foods may aggravate symptoms in some people. Coffee, chocolate, tomatoes, chilli and other spicy foods can also be triggers, although not everyone reacts to the same foods.
In Malaysia, food is an important part of everyday life, and nobody should feel they must abandon every favourite dish because of occasional heartburn. A more practical approach is to identify your own triggers. If a particular meal repeatedly causes symptoms, try reducing the portion, changing the ingredients or eating it earlier in the day.
Other contributing factors include excess weight, smoking, pregnancy and a hiatus hernia, in which part of the stomach moves upwards through the diaphragm. Some medicines, including anti-inflammatory painkillers such as ibuprofen, can also aggravate indigestion. NHS – Heartburn and acid reflux.
What can you do before reaching for medicine?
Simple changes can make a real difference, especially when symptoms are mild or occur mainly after meals.
Eat smaller portions. Rather than having one very large meal, try smaller meals and avoid eating until you feel uncomfortably full.
Give yourself time before bed. Try not to eat for three to four hours before lying down. This is particularly helpful if you experience reflux during the night.
Raise the head of your bed if symptoms disturb your sleep. Raising the head end of the bed by around 10–20 cm may help. Extra pillows alone are not always effective because they can bend the body in a way that increases pressure on the stomach.
Watch your personal food triggers. Keep a simple note of what you eat and when symptoms occur. You may discover that coffee, chocolate, rich foods or spicy meals are more troublesome at certain times or in larger portions.
Consider weight management if appropriate. Excess weight can increase pressure on the stomach and encourage reflux. Gradual weight loss may improve symptoms for some people.
Avoid smoking and limit alcohol. Both may contribute to reflux symptoms.
These measures are recommended in the NHS guidance on managing acid reflux.
Which medicines can help?
This is where a pharmacist can be particularly useful. Different medicines work in different ways, so the best choice depends on how often symptoms occur, how severe they are and what other medicines you take.
Antacids neutralise stomach acid and can provide relatively quick, short-term relief. They are available as liquids or chewable tablets.
Alginates form a protective barrier over the stomach contents, helping to reduce reflux into the oesophagus. Some products combine an alginate with an antacid. These can be useful when symptoms occur after meals or when lying down.
Antacids and alginates are often taken with or soon after food, depending on the product instructions. However, they are not intended to become a permanent solution for symptoms that occur every day. They can also affect the absorption of other medicines, so check the leaflet and ask a pharmacist how far apart to take them. Some preparations contain significant amounts of sodium, which may matter for people who need to restrict salt intake or have certain heart or kidney conditions.
More information is available from NHS – Antacids.
Proton pump inhibitors (PPIs), such as omeprazole or lansoprazole, reduce the amount of acid produced by the stomach. They are commonly used when reflux is frequent or when the oesophagus needs time to recover from acid irritation. A doctor may recommend a course of treatment, often lasting four to eight weeks, depending on the circumstances.
PPIs are not the right answer for every episode of indigestion, and persistent symptoms should not simply be masked with repeated courses of treatment. If you are buying a PPI without a prescription, follow the local product instructions and seek advice if symptoms persist or recur.
A pharmacist can also review whether your existing medicines might be contributing to symptoms. Do not stop prescribed aspirin or other regular medicines on your own, even if you suspect they are irritating your stomach. Ask your pharmacist or doctor to assess the safest option.
When is indigestion a warning sign?
Most occasional indigestion is not serious. The problem is assuming that every episode of burning or chest discomfort must be caused by stomach acid.
Heart problems can sometimes feel like indigestion. A heart attack may cause pressure, tightness, burning or discomfort in the chest, sometimes accompanied by sweating, nausea, breathlessness or pain spreading to the arm, jaw, back or upper abdomen.
If chest discomfort is sudden, persistent or accompanied by these symptoms, seek emergency medical help. Do not try an antacid and wait to see whether it works. See the NHS chest pain guidance.
Arrange prompt medical assessment if you have difficulty or pain swallowing, food sticking in your throat, repeated vomiting, unexplained weight loss, anaemia, a lump in the abdomen, or blood in your vomit or stools. Black, tarry stools can indicate bleeding and need urgent assessment. Persistent or frequently recurring symptoms also deserve medical review, particularly if they are new or worsening.
In Malaysia, you can seek assessment through a Klinik Kesihatan or a private doctor. The clinician may decide whether you need treatment, testing or referral for an examination such as a gastroscopy.
A final word from your pharmacist
Heartburn and indigestion can make everyday life uncomfortable, particularly when they interrupt meals or prevent a good night’s sleep. For occasional symptoms, sensible meal habits and an appropriate pharmacy remedy may be enough.
But if you find yourself reaching for antacids repeatedly, waking at night with reflux or experiencing symptoms most days, do not simply accept it as part of getting older. Persistent reflux deserves attention, and other conditions can sometimes produce similar symptoms.
One final reminder: not every burning sensation in the chest comes from the stomach. Recognising when to seek help is just as important as knowing which medicine to take.
Until next time, take care of your health — and listen when your body tells you something is not right.
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