After studying this module, you will:

Have an understanding of heartburn and indigestion and its signs and   symptoms

Be aware of common causes of heartburn and indigestion

Be able to offer lifestyle advice for managing heartburn and indigestion

Be knowledgeable about the role of OTC products in treating heartburn and indigestion

What is Indigestion?
Indigestion is a general term used to describe discomfort or pain in the upper abdomen or stomach area. When a burning discomfort is felt behind the breastbone, it is known as heartburn.[1] Although both conditions have similar triggers, and the treatment may be the same in some cases, heartburn is not the same thing as indigestion. Customers often use one term when they mean the other so it’s important to find out the exact nature of the symptoms.

<PRACTICE POINT>
Think about the words and phrases your customers use to describe heartburn and indigestion.

What is Heartburn?
Heartburn, or acid reflux, occurs when the lower oesophageal sphincter (LOS) doesn’t close properly and the acid which is normally in the stomach leaks back up into the oesophagus. The LOS (see diagram below) is a ring of muscle at the bottom of the oesophagus that is designed to allow food to enter the stomach, while preventing it from moving back up into the oesophagus.

While the stomach’s lining is protected from acid damage, the delicate tissues of the oesophagus are not, so any acid that leaks up irritates and damages its lining, causing heartburn. This is referred to as reflux. Sufferers of heartburn could experience any of the following symptoms:

• A burning feeling or discomfort around the centre of the chest between the stomach and the back of the throat
• Chest pain that occurs when bending over or lying down, especially soon after eating
• A hot, sour, acidic, or bitter tasting fluid at the back of the throat and/or in the mouth
• A feeling like food coming back into the mouth, or sticking in the chest or throat.

Occasional heartburn is common but if it occurs more than twice a week it may be considered to be gastro-oesophageal reflux disease (GORD), and you should refer the patient to your pharmacist for further advice. Make sure you use the WWHAM* questions when dealing with requests for advice or medicines.

Indigestion
When a person eats, the stomach produces acid, which in turn breaks down the food into chemicals that can be used by the body. Normally the correct amount of acid is produced by the body but sometimes too much is produced. This results in inflammation of the stomach lining, causing the pain and discomfort. It is very common and most people have it from time to time. For some people it’s very mild and doesn’t happen very often, while for others it can be very painful. It may also be accompanied by symptoms of bloatedness, wind, belching and nausea. It is particularly associated with consuming food and drink, but there can sometimes be a delay between eating a meal and experiencing indigestion.

* W - Who is the medicine for?
  W - What is the medicine for?
  H  - How long have the symptoms been present?
  A  - Action already taken?
  M - Medicines taken for other reasons, prescribed or otherwise?