Dyspepsia
Evaluation
General—“bad digestion” translated from Greek
Clinical—varied symptoms → upper abdominal discomfort, early satiety, bloating, nausea, and emesis
Etiology
Forty percent organic—gastroduodenal ulcer (15%-25%), gastroesophageal reflux disease (GERD) (5%-15%), gastric cancer (<A onclick="get_content(event,'AB1-M12'); return false;" onmouseover="window.status=this.title; return true;" onmouseout="window.status=''; return true;" title="<2%)
Sixty percent “functional” or idiopathic—nonulcer dyspepsia
Rome II diagnostic criteria (criteria met for ≥12 weeks)
Persistent or recurrent symptoms (as outlined earlier)
An organic disease not found to explain the symptoms
Diagnosis not better described as irritable bowel syndrome (IBS)
Subclassification of nonulcer dyspepsia
Ulcer-like (“burning” pain)
Dysmotility-like (nausea, bloating or distension, early satiety)
Unspecified
Differential diagnosis of nonulcer dyspepsia
Nonmotility disorders
Gastritis (possible Helicobacter pylori infection)
Duodenitis
Maldigestion/malabsorption of carbohydrates (e.g., lactose intolerance)
Small intestine parasite
Pancreatitis
Psychiatric disorder
Motility disorders
Nonerosive esophageal reflux disease
Gastroparesis
Small intestine dysmotility
Biliary dysmotility
Diagnostic approach to dyspepsia
Triage by history
If serious risk factors (age 50 years or older, dysphagia, palpable mass, unexplained weight loss, protracted vomiting, or evidence of bleeding), then work up with endoscopy, and so on.
If no serious risk factors or above-mentioned workup is negative, then consider nonulcer dyspepsia.
Treat with a trial of antisecretory medications.
Antacids—usually provide little help, especially for chronic dyspepsia
