Definition
Dyspepsia is the feeling of discomfort or pain in the upper abdomen or lower chest. Indigestion may be used by the patient to mean dyspepsia, regurgitation symptoms or flatulence.
Key Points
- Dyspepsia may be the only presenting symptom of upper GI malignancy. All older patients and patients with alarm symptoms (dysphagia, vomiting, anorexia and weight loss, GI bleeding) should have endoscopy.
- Dyspepsia in young people without alarm symptoms is very unlikely to be due to malignancy.
- In young adults, gastro-oesophageal reflux and Helicobacter pylori-positive gastritis are common causes.
- Dyspepsia is rarely the only symptom of gallstones – they are more often incidental findings.
Differential Diagnosis
Oesophagus
- Reflux oesophagitis: retrosternal dyspepsia, worse after large meal/lying down, associated symptoms of regurgitation, pain on swallowing.
- Oesophageal carcinoma: new-onset dyspepsia in older patient, associated symptoms of dysphagia/weight loss/haematemesis, failure to respond to acid suppression treatment.
Stomach
- Gastritis: recurrent episodes of epigastric pain, transient or short-lived symptoms, may be associated with diet, responds well to antacids/acid suppression.
- Gastric ulcer: typically chronic epigastric pain, worse with food, ‘food fear’ may lead to weight loss, exacerbated by smoking/alcohol, occasionally relieved by vomiting.
- Carcinoma of the stomach: progressive symptoms, associated weight loss/anorexia, iron-deficient anaemia common, early satiety, epigastric mass.
- Hiatus hernia: recurrent epigastric and retrosternal discomfort, may be associated with diet, symptoms of reflux, may respond to acid suppression.
Duodenum
- Duodenal ulcer: epigastric and back pain, chronic exacerbations lasting several weeks, relieved by food especially milky drinks, relieved by bed rest, more common in younger men, associated with H. pylori infection.
- Duodenitis: often transient, mild symptoms only, associated with alcohol and smoking.
Gallstones
Dyspepsia is rarely the only symptom, associated RUQ pain, needs normal OGD and positive ultrasound to be considered as cause for dyspeptic symptoms.
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