Usually benign — but it is worth knowing which features mean it is not.
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Indigestion — dyspepsia — is pain or discomfort in the upper abdomen, often with bloating, fullness after small meals, belching or nausea. It is extremely common, and in most people the stomach lining and gullet are entirely normal when looked at. That does not make the symptoms imaginary; it means the problem is how the stomach is behaving rather than what it looks like.
There are three things this page exists to say.
First: "indigestion" is what a significant number of people call a heart attack. Central chest discomfort with sweating, nausea, or pain into the jaw or left arm — particularly if it comes on with exertion — is cardiac until proven otherwise. People die of this misattribution, and it is more common in women, in people with diabetes, and in anyone who has had indigestion before and assumed this was the same thing.
Second: Helicobacter pylori is the single most useful thing to test for, and it is routinely missed. It is a treatable bacterial infection of the stomach lining, it causes ulcers, and a two-week course of treatment can resolve years of symptoms permanently. Long-term acid suppression without ever testing for it is a common and avoidable mistake.
Third: it is not the same as acid reflux. Reflux is heartburn rising behind the breastbone with an acid taste; indigestion is discomfort centred in the upper abdomen. They overlap and often coexist, but the investigation differs.
Any of these means investigation rather than treatment:
Most indigestion is diagnosed from the history. A video consultation does this well, and it lets us do the two things that matter most: screen for red flags, and arrange H. pylori testing.
Endoscopy is the definitive test and cannot be done remotely. We arrange referral — urgent, on the two-week cancer pathway, where there is difficulty swallowing, weight loss, bleeding, anaemia, or new persistent symptoms over 55. Suspected bleeding or possible cardiac pain goes to hospital the same day, not to a referral letter.
Before anything else. Where the pattern suggests cardiac disease, the correct treatment for indigestion is an ECG and a cardiology assessment — not an antacid. We would rather investigate ten stomachs than miss one heart.
Frequently the whole answer. Anti-inflammatories — including the ones you buy yourself — are the commonest treatable cause. We review your medication, and where an anti-inflammatory is genuinely needed, we prescribe stomach protection alongside it.
The step most worth taking. If the test is positive, eradication is a one to two week course of two antibiotics plus a proton pump inhibitor. It cures the underlying problem rather than suppressing symptoms, and for people who have had indigestion for years it can be the end of it.
Two things determine whether it works: finishing the full course even once you feel better, and a follow-up test at least four weeks later to confirm it has gone — which is routinely skipped, and which we will arrange.
Where investigation is normal, treatment is still available and worth taking seriously:
Call 999 for:
Seek same-day advice for:
Arrange an urgent appointment for:
Book a routine appointment for:
Triggers are individual, and blanket elimination diets tend to cost more quality of life than they return. Keep a brief diary for two weeks, identify your triggers, and restrict only those. Common ones: fatty and fried food, spicy food, tomato, citrus, chocolate, coffee, fizzy drinks, mint.
Use paracetamol rather than ibuprofen for everyday pain if you are prone to indigestion. If you need an anti-inflammatory regularly — for arthritis, for instance — that is a conversation about stomach protection rather than something to manage alone.
Not a way of dismissing the symptoms. Stress and poor sleep genuinely alter how the gut senses stretch and pain, which is why functional dyspepsia flares in difficult periods. Anything that reliably reduces your stress load is legitimate treatment here.
Antacids, alginates and low-dose omeprazole are all available over the counter cheaply, and for occasional indigestion that is the right answer. Your NHS GP treats it free.
The question worth asking, and the one most often skipped, is whether Helicobacter pylori has ever been tested for. It is the commonest treatable cause of persistent indigestion and ulcers, the test is non-invasive — a breath or stool test — and eradicating it can end the problem permanently rather than managing it for years.
The practical detail that catches people out: stop any proton pump inhibitor for two weeks before testing, or the result can be falsely negative.
Where a consultation is genuinely worth paying for is arranging that testing promptly, reviewing medicines — anti-inflammatories are a very common cause and are frequently not connected to the symptoms — and, where a PPI has been taken for years without review, planning a proper taper.
What must not simply be treated with acid suppression: difficulty swallowing, unintended weight loss, persistent vomiting, black or tarry stools, anaemia, or new indigestion over the age of 55. Those warrant endoscopy, and acid suppression is very effective at masking them — which is precisely the danger.
NHS endoscopy through the urgent pathway is fast and free, and is the right route where those features are present.
NICE CG184, Gastro-oesophageal reflux disease and dyspepsia in adults, is the governing guideline. It recommends a test-and-treat approach for H. pylori in uninvestigated dyspepsia, or a trial of full-dose PPI for four weeks.
CG184 advises stopping PPIs two weeks and antibiotics four weeks before H. pylori testing to avoid false negatives — the basis for the practical point above.
CG184 recommends reviewing medication that may cause dyspepsia, including NSAIDs, aspirin, bisphosphonates, calcium antagonists and steroids.
CG184 recommends annual review of long-term acid suppression, with stepping down or stopping where appropriate.
NICE NG12, Suspected cancer, defines urgent direct-access endoscopy criteria — dysphagia at any age, and upper abdominal symptoms with weight loss or aged 55 and over — which underpin the safety advice above.
You often cannot, and that is the point. The features that should worry you: discomfort brought on by exertion and eased by rest, central pressure rather than burning, radiation to jaw, neck, back or arm, and sweating, breathlessness or nausea alongside. Heart attacks are regularly mistaken for indigestion — more often in women and in people with diabetes. If in doubt, call 999. Nobody will think you wasted their time.
A bacterium that lives in the stomach lining, causes ulcers, and is curable with a one to two week course. If you have had indigestion for more than a few weeks and never been tested, yes — test. It is the only common cause you can eliminate permanently rather than manage, and it is the step most often skipped.
Check the timing. A proton pump inhibitor taken within two weeks of the test, or antibiotics within four weeks, can make it falsely negative. This is the commonest reason a real infection is missed, and it is rarely explained beforehand. If that applies to you, the test is worth repeating properly.
Frequently the timing. These drugs only act on acid pumps that are actively working, so they need to be taken 30 to 60 minutes before your first meal of the day — not at bedtime, not with food, not as needed. Taken correctly they are considerably more effective, and most people are never told this.
For many people the benefit outweighs the risk, and some conditions require it long term. But it should be a deliberate decision reviewed periodically, not a repeat prescription nobody has looked at. Long-term use without ever testing for H. pylori is the part worth correcting, and stepping down to the lowest effective dose is often possible.
No, though they overlap and frequently coexist. Reflux is burning rising behind the breastbone with an acid or bitter taste; indigestion is discomfort in the upper abdomen with fullness, bloating or nausea. The distinction matters because it changes what we test for — see our acid reflux page.
Most likely functional dyspepsia — a stomach that empties slowly or is unusually sensitive to normal stretching. A normal endoscopy means nothing dangerous is there; it does not mean nothing is wrong. It is a real diagnosis with real treatments, including low-dose tricyclics that work on gut nerve signalling rather than mood.
Get tested first. Coeliac blood tests require you to have been eating gluten regularly for at least six weeks; cutting it out beforehand makes the test unreliable and means the diagnosis is either missed or requires months of reintroduction to confirm. Coeliac disease presents as indigestion and bloating far more often than most people realise, so it is worth doing properly.
Very possibly. Ibuprofen, naproxen and aspirin are the leading drug cause of indigestion and ulcers, including at over-the-counter doses. Tell us about anything you buy yourself — it is the detail most often left out, and sometimes the whole answer. Paracetamol is the safer everyday alternative for the stomach.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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