Dyspepsia, from the Greek duspeptos meaning "difficult to digest", is a broad term defined as one or more of:
- post-prandial fullness (after a meal)
- early satiety (unable to finish a meal)
- epigastric pain or burning
- heartburn (retrosternal pain or burning)
Dyspepsia vs. Indigestion
Dyspepsia must not be confused with indigestion, which is a vague term used by patients to describe dyspepsia, bloating, nausea or vomiting. Find out exactly what your patient means!
The stomach is a battlefield between the forces of attack and defence. Managing dyspepsia is about maintaining the balance of power, a careful equilibrium between the two sides:
|- gastric acid
- Helicobacter pylori
- bile salts
- cellular mucous
- mucosal blood flow
- cello turnover
- post-prandial fullness
- early satiety
- epigastric pain, tenderness or burning, often related to hunger, specific food or time of day
- ALARM Symptoms:
- Anaemia (iron deficiency)
- Loss of weight
- Recent onset/progressive symptoms
- Swallowing difficulty
OGD: oesophagogastroduodenoscopy (upper GI endoscopy)
Drugs which cause dyspepsia: NSAIDs e.g. ibuprofen
Lifestyle changes: stop smoking, decrease alcohol intake, avoid aggravating foods, avoid stress
Antacids: available over-the-counter e.g. magnesium trisilicate
Test for H. pylori: urea breath test, stool antigen, serology etc
PPI: proton pump inhibitor e.g. omeprazole, lansoprazole
H2 blocker: Histamine H2-receptor antagonist e.g. ranitidine
Triple therapy: omeprazole 20 mg + amoxicillin 1g + clarithromycin 500 mg OR lanzoprazole 30 mg + metroidazole 400 mg + clarithromycin 250 mg BD for one week
What might you find on OGD?
- <33% will show anything significant
- functional dyspepsia: with no organic pathology, PPIs and psychotherapy may help
- peptic ulcers: duodenal or gastric
- a common cause of dyspepsia
- cancer: oesophageal, gastric
- benign strictures
- Barrett's oesophagus
- Longmore M et al. Oxford Handbook of Clinical Medicine. 9th ed. Oxford: Oxford University Press, 2014.
- Martin EA (ed.). Concise Medical Dictionary. 8th ed. Oxford: Oxford University Press, 2010.
- Ah-See KW et al. BNF 65. London: BMJ Group, 2013.
- Sadowski DC et al. Five Things to Know About... Dyspepsia. CMAJ 2015;187(4):doi:10.1503/cmaj.141606.
- Holtmann G, Talley NJ. Functional dyspepsia. Curr Opin Gastroenterol 2015;31(6):492-8.