Persistent indigestion can signal serious disease, doctors say

A University of Bristol GP has warned that persistent or worsening indigestion and heartburn should not be ignored because they can sometimes indicate serious underlying conditions, including upper gastrointestinal cancers.

Indigestion — which can cause heartburn, acid reflux and a burning sensation in the upper abdomen or chest — affects more than 40% of people in the U.K. each year, according to clinical commentary. In most cases symptoms follow a trigger such as a rich meal, alcohol or certain medications and resolve within hours; however, clinicians say symptoms that persist, change in severity or are accompanied by other worrying signs require medical assessment.

Clinicians list several common, usually benign causes of indigestion. A hiatus hernia, where part of the stomach pushes through the diaphragm, increases the likelihood of acid reflux and is common among older adults. Frequent consumption of coffee, spicy or fatty foods, alcohol intake, obesity, pregnancy and smoking are recognised risk factors. A range of medications — including some antidepressants, non-steroidal anti-inflammatory drugs and iron tablets — can also trigger symptoms.

But doctors caution that persistent dyspepsia can be a symptom of more serious disease. Dr. Dan Baumgardt, a Bristol-based GP and senior lecturer at the University of Bristol, wrote that while over-the-counter remedies may provide short-term relief, ‘‘indigestion is common but not always harmless.’’ He said persistent heartburn, new or worsening difficulty swallowing (dysphagia), unexplained weight loss, upper abdominal pain, feeling full after small meals and recurrent vomiting should prompt evaluation.

Inflammation of the oesophagus, stomach or duodenum can be caused by infection with Helicobacter pylori, a bacterium implicated in peptic ulcers; treatment commonly involves antibiotics and proton pump inhibitors. Left untreated, peptic ulcers can lead to serious complications such as bleeding or perforation. Some heart conditions, including ischemic heart disease, can present with symptoms that mimic indigestion or chest discomfort and may need urgent assessment.

Upper gastrointestinal cancers, including oesophageal cancer, can present with prolonged or progressive symptoms. To investigate suspected cancer, clinicians typically arrange endoscopy, a procedure in which a flexible camera examines the upper gastrointestinal tract. Other malignancies that are difficult to detect early, such as pancreatic and ovarian cancer, can also cause indigestion among other symptoms, and may prompt further imaging and tests.

Patients who vomit blood, pass black or tarry stools, or collapse should seek emergency care, clinicians say. For non-emergency but concerning symptoms — persistent pain, progressive swallowing difficulties, unexplained weight loss or ongoing vomiting — primary care assessment is advised so a doctor can take a history, perform an examination and order appropriate investigations.

The debate about treatment includes caution over long-term use of proton pump inhibitors (PPIs) such as omeprazole. Pharmacist Deborah Grayson, speaking on social media, said PPIs can provide short-term relief by suppressing stomach acid but may have longer-term effects on digestion, potentially contributing to bloating, nausea, weight changes and nutrient deficiencies. NHS prescription data show PPIs remain among the most commonly dispensed drugs in England, with about 73 million prescriptions in 2022–23 at an estimated cost of £190 million.

Clinicians say that while PPIs are appropriate for conditions such as erosive oesophagitis or confirmed Helicobacter pylori infection, treatment should be reviewed with a doctor to weigh benefits and risks. They emphasise that people should not try to self-diagnose: a clinician can combine symptom patterns, risk factors and test results to identify causes and recommend suitable treatment or referrals.

The guidance from GPs and pharmacists underlines a common theme in primary care: brief, isolated episodes of indigestion are usually benign, but persistent, progressive or unusual symptoms warrant prompt medical attention to rule out treatable or serious conditions.