Dyspepsia

NOT a diagnosis but a description of symptoms that may indicate disease of the upper GI tract

Aetiology

Organic causes (25%)

  • GORD
  • Peptic ulcer disease
  • Drugs (especially NSAIDs and COX2 inhibitors)
  • Gastric cancer

Functional dyspepsia (75%)

  • No evidence of culprit structural disease
  • Associated with other functional gut disorders e.g. IBS

Clinical presentation

Rome III criteria

  • Epigastric pain/burning
  • Postprandial fullness
  • Early satiety

Signs

  • If uncomplicated - epigastric tenderness only
  • If complicated - cachexia, mass, evidence of gastric outflow obstruction, peritonism

Investigations + management

If no alarm symptoms and < 60

  • Check H. pylori status
  • Positive → eradicate
  • Negative → acid inhibition

Alarm symptoms and/or ≳ 60

  • Endoscopy
  • Check H. pylori status