Steve

I suffer with indigestion at night

I'm a 57 year old male. I've been given lansoprazole 30mg once per day by my doctor after I complained about indigestion and bloating (not heartburn) every night between 3.00am and 4.00am. I don’t have symptoms at any other time. Isn't this just treating the symptoms not the cause? What tests could I be having to identify the root cause? I've been on Lansoprazole for three months with no improvement.

28 March 2019

Thank you for your enquiry. From the symptoms you describe (indigestion and bloating, highlighting that there is no reflux involved), it’s possible that you are suffering from what is known as dyspepsia.

Dyspepsia is also known as indigestion or heartburn and is a common but ill-defined disorder, primarily associated with discomfort or pain in your upper abdomen (just below the ribs), accompanied by symptoms such as nausea, fullness or belching.

What causes indigestion and heartburn?

The burning feeling and discomfort associated with indigestion and heartburn is caused by stomach acid rising up and irritating the lining of your oesophagus, the pipe that connects your mouth to your stomach.

Treating indigestion and heartburn

Lifestyle changes to help with heartburn

You may be aware that there are several lifestyle measures recommended to patients suffering with dyspepsia that may or may not apply in your case. These include:

  • avoiding alcohol
  • cutting down on caffeine
  • stopping smoking
  • maintaining a healthy body mass index (BMI)
  • avoiding aggravating foods (see below)
  • eating small, regular meals to aid digestion, and
  • not eating late at night or just before bedtime.

As you’d expect, diet plays a major part in causing – and controlling – heartburn.

Foods that aggravate heartburn

Here are some common culprits you might want to avoid:

  • High-fat foods (including foods high in healthy fats, such as avocados and nuts
  • Spicy foods
  • Raw onions and garlic
  • Tomatoes
  • Chocolate
  • Citrus juices
  • Fizzy drinks.

Foods that may relieve heartburn

...and here are some foods that may help relieve symptoms:

  • Oatmeal
  • Bananas
  • Melon
  • Green vegetables
  • Ginger (interestingly mint, which is often considered to be soothing for the gut could actually cause heartburn).

Medication for heartburn

Alongside lifestyle modifications, drug treatment is often initiated – in your case, with lansoprazole.

Note that over the counter remedies called antacids are also available for the treatment of heartburn and acid reflux, but it’s important to check with the pharmacist that it’s safe for you to take them because they’re not suitable for everyone.

Lansoprazole belongs to a family called proton-pump inhibitors (PPIs).  Other widely used PPIs include esomeprazole, omeprazole, pantoprazole and rabeprazole. They work by blocking the acid-secreting (proton pump) system found in the cells of the stomach lining, thereby significantly reducing the amount of gastric acid produced.

H2 (histamin-2) blockers are another group of medications used to treat heartburn and acid reflux. They work by inhibiting the absorption of histamine by acid-producing cells in the stomach, interfering with the chemical reaction that creates the acid so that less is produced. H2 blockers include ranitidine, cimetidine, famotidine and nizatidine.

Next steps

The treatment you have received so far is in line with UK national prescribing guidance, i.e. lansoprazole 30mg once a day is a recommended dose for dyspepsia symptoms not investigated by endoscopy. Treatment with a proton pump inhibitor in uninvestigated dyspepsia is recommended for four weeks. The guidance goes on to say that patients with uninvestigated dyspepsia who do not respond to this initial trial should return for a follow-up for further testing.

So in summary, with respect to your presenting symptoms and initial drug treatment, this has followed standard protocol, but as you have exceeded the four-week initiation and have now suffered for three-months without any improvement, it would be best practice to return to your GP for further investigation. If you want to discuss this matter further then please do not hesitate to contact us again.

Answered by Health at Hand team

Further reading

Tips for a healthier gut – AXA PPP healthcare
Love your gut: Exercises to improve digestion – AXA PPP healthcare

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