What causes persistent indigestion?

Persistent indigestion may be caused by reflux, medicines, Helicobacter pylori infection, an ulcer, or an oesophageal or stomach condition. Barrett's Oesophagus, oesophageal cancer, and stomach cancer can present with indigestion, but the symptom alone does not show which cause is present.

Indigestion may feel like burning, upper-abdominal discomfort, early fullness, bloating, belching, nausea, or food coming back up. A clinician will ask about meals, alcohol, smoking, medicines such as anti-inflammatory painkillers, swallowing, vomiting, bowel changes, and unplanned weight loss. Helicobacter pylori infection can irritate the stomach lining. Long-standing reflux can affect the oesophagus and may lead to Barrett's Oesophagus. Persistent symptoms may need testing rather than repeated self-treatment.

Arrange a medical review when indigestion persists, keeps returning, or changes from your usual pattern. Bring a list of medicines and note foods, timing, pain location, swallowing symptoms, vomiting, and stool changes. Smaller meals and avoiding lying down soon after eating may reduce reflux for some people. Ask before stopping prescribed medicine or using acid-suppressing treatment for a prolonged period. Your clinician may test for Helicobacter pylori or consider an endoscopy based on your symptoms and examination.

Seek urgent help for vomiting blood, black stools, severe or worsening abdominal pain, repeated vomiting, inability to swallow fluids, chest pain, fainting, or marked weakness. Prompt assessment is also needed for progressive difficulty swallowing, persistent vomiting, or unexplained weight loss.

Could reflux, an ulcer, Helicobacter pylori, or a medicine explain this? Do I need testing or an endoscopy? Which warning symptoms should make me seek help sooner?