Dyspepsia
Dyspepsia is chronic or recurrent epigastric pain, burning, postprandial fullness, or early satiety that is organic when a structural, metabolic, or drug cause is found and functional when Rome IV criteria are met after a negative workup. Management starts with an alarm-feature screen that mandates prompt upper endoscopy, then test-and-treat for Helicobacter pylori, then an empiric proton pump inhibitor trial, reserving a tricyclic or prokinetic agent for confirmed functional disease.
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What this article covers
- Overview
Definition: dyspepsia is chronic or recurrent epigastric pain or discomfort, with associated early satiety, postprandial fullness, epigastric burning, nausea, or bloating; heartburn may coexist but…
- Epidemiology
High prevalence: functional dyspepsia affects approximately 20% of the US population, one of the most common functional gastrointestinal disorders and reasons for gastroenterology referral.
- Risk factors
NSAID or aspirin use: the leading modifiable risk factor for organic dyspepsia through peptic ulcer disease and NSAID gastropathy.
- Pathophysiology
Organic dyspepsia: a structural or biochemical lesion directly produces the symptom, for example acid-peptic injury in peptic ulcer disease, mucosal inflammation in H.
- Clinical features
Core symptom complex: epigastric pain or burning, early satiety, and postprandial fullness, sometimes with bloating, belching, or nausea; heartburn may be present but reflects coexisting reflux rather than dyspepsia itself.
- Differential diagnosis
Peptic ulcer disease: epigastric pain classically worse fasting and improved with eating or antacids, confirmed by endoscopy and often associated with H.
- Diagnosis
Establish the diagnosis by an ordered clinical pathway, not a single test: functional dyspepsia is diagnosed by Rome IV criteria only after alarm features and, when appropriate, structural and H.
- Management
Treat any identified organic cause directly: eradicate H.
- Complications
Missed malignancy from inappropriate reassurance: delayed diagnosis of gastric or esophageal cancer if alarm features or the age-60 threshold are not respected.
- Prognosis
Organic dyspepsia: prognosis tracks the underlying cause; peptic ulcer disease and H.
- Prevention
Endoscopy threshold to prevent missed malignancy: endoscope every patient with new dyspepsia at age 60 or older, and below age 60 only for multiple or severe alarm features, emigration from a…
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Related articles
- Peptic ulcer disease
Peptic ulcer disease is a mucosal break in the stomach or duodenum caused chiefly by Helicobacter pylori infection or NSAID use, diagnosed by upper endoscopy with biopsy of gastric ulcers to exclude malignancy. Treatment eradicates H. pylori when present, stops the ulcerogenic drug, and heals the ulcer with a proton pump inhibitor, while its complications of bleeding, perforation, and obstruction drive most of its morbidity.
- Gastroesophageal reflux disease (GERD)
GERD is retrograde reflux of gastric contents into the esophagus causing heartburn and regurgitation, diagnosed clinically and confirmed by response to an empiric PPI trial, with endoscopy reserved for alarm features or refractory symptoms. Management proceeds from lifestyle measures through an 8-week once-daily PPI trial, dose escalation or agent switch for partial response, and fundoplication for medication-refractory or regurgitation-predominant disease.
- Gastric cancer
Gastric cancer is mostly adenocarcinoma, split into an H. pylori-driven intestinal type arising through chronic atrophic gastritis and intestinal metaplasia and a diffuse signet-ring type causing linitis plastica, and it typically presents late with alarm dyspepsia and weight loss. Upper endoscopy with biopsy confirms the diagnosis, TNM stage with endoscopic ultrasound, CT, and diagnostic laparoscopy sets treatment, and management ranges from endoscopic resection for early T1a disease to gastrectomy with D2 lymphadenectomy and perioperative FLOT chemotherapy for resectable disease to palliative chemotherapy for advanced disease.
- Gastroparesis
Gastroparesis is delayed gastric emptying without mechanical obstruction, most often from longstanding diabetes, prior gastric surgery, or an idiopathic postviral course, presenting with nausea, vomiting, early satiety, and postprandial fullness. Diagnosis requires upper endoscopy to exclude obstruction followed by objective gastric emptying testing, and management progresses from glycemic control and dietary change through time-limited prokinetics to device or endoscopic therapy for refractory disease.
- Celiac disease
Celiac disease is an immune-mediated small-intestinal enteropathy triggered by dietary gluten in genetically predisposed individuals, presenting with malabsorptive diarrhea, iron-deficiency anemia, or dermatitis herpetiformis. Diagnosis requires IgA tissue transglutaminase serology with a total IgA level while the patient still eats gluten, confirmed by duodenal biopsy showing villous atrophy, and the only treatment is a strict lifelong gluten-free diet.
- Irritable bowel syndrome (IBS)
Irritable bowel syndrome is a functional disorder of gut-brain interaction diagnosed clinically by Rome IV criteria, recurrent abdominal pain related to defecation, stool frequency, or stool form, without alarm features. Management is subtyped by stool pattern, with fiber and dietary change first, then IBS-C secretagogues or IBS-D antidiarrheals and antibiotics, and low-dose tricyclics or antispasmodics for pain.