Someone, somewhere, is pressing his palm against his chest right now after a meal. He tells himself it will pass. It usually does. So he eats the same way tomorrow and the next day. After a few years, he quietly accepts the burning as part of his life. He is not alone. Across the world, hundreds of millions do the same, reaching for antacids the same way others reach for paracetamol. They manage a condition they rarely name and almost never treat properly.
Chronic indigestion, known medically as functional dyspepsia, is not a fancy term for overeating. It is a persistent, recurring condition affecting the upper digestive tract. It is characterised by pain or discomfort in the upper abdomen, uncomfortable fullness after meals, early satiety, and sometimes nausea. A 2024 systematic review and meta-analysis published in Scientific Reports put the global prevalence in adults at approximately 8.4%. That translates to hundreds of millions of people. Yet functional dyspepsia remains underdiagnosed, particularly in low- and middle-income countries, where symptoms tend to be blamed on stress, bad food, or spiritual causes rather than investigated properly.
Now, part of what makes this condition frustrating is that it does not always manifest the same way. For some people, it is a distressing, burning sensation in the middle upper abdomen, which shows up without an obvious cause. For others, it is a heaviness that starts before a meal is even done or a bloating that lingers for hours afterwards. Most people feel consistently uncomfortable in a way that is difficult to explain to a doctor, especially when the endoscopy comes back normal.
By definition, functional dyspepsia is diagnosed when structural abnormalities like active Helicobacter pylori infection or ulcers have been excluded. It is categorised as a disorder of gut-brain interaction. The brain amplifies signals from the gut in ways that produce real pain without any visible tissue damage. A scan does not detect any of that.
In Nigeria, the picture is complicated by one particularly striking fact. According to data cited by the World Gastroenterology Organization, Nigeria has the highest recorded prevalence of Helicobacter pylori infection globally, at approximately 87.7% of the population. This is driven by poor sanitation, contaminated water, and overcrowded living conditions. The bacteria do not always produce symptoms, but when they do, they are clinically indistinguishable from functional dyspepsia without proper testing. In most Nigerian primary healthcare facilities, testing is simply not available. This means many people with a curable infection are instead handed antacids and sent home.
Diet matters too, though not in the way people assume. Traditional Nigerian ingredients are not the problem. The issue is habit. Eating quickly. Going long hours without food and then eating a very large meal in one sitting. Lying down within an hour of eating. Drinking heavily carbonated drinks with meals. All of these impose real mechanical and chemical stress on the stomach. So does the widespread, unguided use of ibuprofen and other non-steroidal anti-inflammatory drugs sold cheaply and without prescription across the country and taken routinely for pain and fever. Most people who take them do not know that they are a significant risk factor for upper gastrointestinal irritation.
Psychological stress is another factor that gets overlooked. The gut-brain axis is highly sensitive to anxiety and chronic mental strain. Research coordinated through the Rome Foundation, which sets international standards for diagnosing gut-brain disorders, has consistently shown that people with untreated psychological distress are significantly more likely to experience persistent digestive symptoms. In a context where mental health support carries stigma and is largely out of reach for most people, it creates a loop that is difficult to break without addressing both ends.
Now, none of this means chronic indigestion is entirely a systemic failure, though the system does fail people. The specialist shortage is real. Diagnostic equipment is scarce. Primary care is overstretched. However, functional dyspepsia is also, in a meaningful part, a lifestyle condition and a matter of personal choices. Eating smaller meals more frequently reduces the burden on the stomach. Chewing slowly gives digestive enzymes time to work before food reaches the stomach. Not eating within 2 to 3 hours before lying down reduces the incidence of acid reflux. Cutting back on alcohol and carbonated drinks removes common chemical irritants. None of this requires a prescription or a hospital visit.
The self-medication problem deserves particular attention. Many Nigerians take proton pump inhibitors (PPIs), antacids, or H2 blockers daily for years without medical guidance, managing symptoms they have never properly investigated. Long-term unsupervised use of proton pump inhibitors carries real risks. The US Food and Drug Administration has issued formal warnings about low magnesium levels associated with prolonged use of PPIs, and there is growing evidence of links to intestinal infections, including Clostridium difficile. More fundamentally, suppressing symptoms without addressing their cause leaves treatable conditions untreated. Helicobacter pylori, which affects nearly 9 in 10 Nigerians, can be cured with a short course of antibiotics. However, many people are living with it without knowing it.
The truth is that knowing when to see a doctor is itself a form of personal responsibility. New indigestion in someone over 55, or symptoms that come with unintentional weight loss, difficulty swallowing, blood in vomit, or black, tarry stools, are red flags that need urgent medical attention. They may point to something far more serious. Nigeria has among the lower recorded incidence rates for gastric cancer in sub-Saharan Africa, but the disease exists here, and patients overwhelmingly present with advanced disease. The years of self-treatment that precede that presentation are not secondary to this outcome.
We will not solve the problem of chronic indigestion by building more endoscopy units alone, though we need them. We will not solve it by training more gastroenterologists alone, though we need them too. A large part of the solution lies in how we respond to our own bodies. This includes understanding that persistent discomfort is not a character test to be endured, making different choices at the dinner table and the chemist counter, and not letting pride stand between us and a clinic.
If you constantly press your palm to your chest after a meal, it is high time you looked for a lasting solution. The means to improve your situation exist, many of them free and many of them within your reach. You just have to listen to your stomach and act urgently on the message you get.
Ojenagbon, a health communication expert and certified management trainer, lives in Lagos.