Every so often, a completely random advert stops me in my tracks and makes me wonder what on earth went on in the room where it was created. For me, that moment came this past weekend, courtesy of a bubblegum-pink, cheerfully surreal advert for Pepto-Bismol.
Author
- Dan Baumgardt
Senior Lecturer, School of Psychology and Neuroscience, University of Bristol
Pepto-Bismol has been around since 1901, when it was first designed to ease the symptoms of cholera . Over the decades, it's evolved into the familiar pink liquid we know today, promising to treat nausea, heartburn, indigestion and - as their jingle suggests - diarrhoea-ah!
Absurd advert? Definitely. But effective nonetheless, since it actually got me thinking about Pepto-Bismol for the first time in years. And, to its credit, the advertisers slipped in a piece of genuinely useful advice: that if your symptoms persist, see a doctor. That matters, because ongoing indigestion can be a sign of something more serious.
Understanding the upper gastrointestinal tract
In medicine, the gut is divided into two regions: upper and lower. The upper tract includes the mouth, pharynx, oesophagus (or gullet), stomach and the first section of the small intestine: the duodenum. Symptoms from these areas can point to a range of conditions.
One common cluster is dyspepsia : discomfort or pain often accompanied by bloating, burping, nausea and a feeling of fullness. Most of us will have experienced it at some point.
It can also involve reflux - the sensation of stomach contents coming back up - or waterbrash , a bitter taste from stomach acid hitting the back of the throat. Patients describe these in many ways: heartburn, acid reflux or "food that repeats on you".
Pharmacies offer a wide range of remedies to treat indigestion. The familiar Pepto-Bismol is just one example. Alginates, such as Gaviscon, are medicines that contain seaweed-derived compounds which form a protective "raft" that floats on top of stomach contents, reducing reflux and preventing irritation of the stomach wall by acid. Chewable tablets like Rennies neutralise stomach acid. Even acid-reducing medications like omeprazole can be purchased over the counter. While these can ease symptoms, they can also delay diagnosis and treatment of potentially serious conditions if relied upon for long periods of time.
What causes indigestion?
After a rich or spicy meal or a stomach bug, some indigestion is expected - and might last a few days. Indigestion can also stem from benign conditions such as a hiatus hernia , where part of the stomach pushes through the diaphragm into the chest, making reflux more likely. This is common: it's estimated that around a third of people over 50 may have one.
Other risk factors include coffee, alcohol, spicy or fatty foods, large portions, pregnancy, obesity and smoking. Some medications, including antidepressants, ibuprofen, anti-inflammatories and iron tablets, can also trigger symptoms.
However, persistent dyspepsia can sometimes be linked to more serious conditions. Inflammation of the oesophagus, stomach or duodenum has many causes, including infection with Helicobacter pylori a common bacteria that can live in the stomach lining and is a leading cause of ulcers. Antibiotics and omeprazole may be required to treat it. In some cases, this infection can progress to a peptic ulcer , which carries serious risks of bleeding or perforation of the gut.
More worryingly, indigestion can occasionally be a symptom of upper gastrointestinal cancers . In such cases, an endoscopy - a flexible camera that examines the upper gut - may be needed, with alternative tests available for those unable to tolerate the procedure.
Other internal cancers can also cause indigestion among other symptoms, including pancreatic and ovarian cancer . Even cardiac chest pain can mimic indigestion.
Symptoms can vary considerably between different conditions and different patients. This is why it's important not to self-diagnose, and seek medical advice so a doctor can put the pieces together and make an appropriate plan of action.
When to worry
Guidelines from the National Institute for Health and Care Excellence (NICE) - an independent public body that provides national guidance and advice to improve health and social care in England - recommend urgent investigation with endoscopy for patients with a mass in the abdomen or who experience difficulty swallowing (dysphagia). Unexplained weight loss or upper abdominal pain alongside indigestion are also concerning, especially for patients in their 50s, where the risk of cancer is higher .
Investigation may also be considered for persistent indigestion, or that which doesn't respond to treatment and in patients with iron-deficiency anaemia or a history of peptic ulcers. Family history is also relevant. Having two first-degree relatives (close family such as parents, siblings or children) with upper gastrointestinal cancer is another risk factor .
Acute gastrointestinal bleeding associated with cancer or an ulcer is an emergency. This can present as vomiting blood - either fresh red or looking like coffee-grounds. Some patients can pass blood mixed in their poo or black, tarry, foul-smelling stools. This "melaena" indicates digested blood. Here, immediate hospital care is essential.
Other warning signs include the presence of jaundice (yellowing of the skin), nausea and vomiting, altered bowel habits and tiredness. And since conditions like ischaemic heart disease (a narrowing of the heart's blood vessels that can restrict blood flow and cause chest pain) may present like indigestion, vigilance is important for cardiac symptoms , especially in people with risk factors .
While advertising for Pepto-Bismol might spark a smile (or grimace), here's the reality check: indigestion is common but not always harmless. Over-the-counter treatments can provide relief and many benign conditions often prove to be the underlying cause. But in some cases, persistent symptoms may signal a more serious underlying condition, including cancer.
So, if it's a recurrent, persistent or severe problem, or you notice other worrying changes , skip a refill at the self-medication aisle. Make an appointment with your GP instead. Sometimes that pink bottle isn't enough and catching problems early can make all the difference.
Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
