Related to this topic: Leaflets | Patient+ | UK Guidelines | Online Videos | Weblinks | Medicines | Pharmacy | Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Dyspepsia
Dyspepsia describes pain or discomfort in the upper abdomen, and has been defined in a variety of different ways by a number of expert groups.
- Prior to 1991 dyspepsia included patients with symptoms of heartburn and acid reflux.1
- The Rome I definition defined patients with sole reflux symptoms as having gastro-oesophageal reflux disease (GERD or GORD).2
- More recently the these criteria have been extended to exclude patients with predominant reflux symptoms and symptoms suggestive of irritable bowel syndrome.3
The costs of managing dyspepsia outstrip all other conditions in the NHS. Expenditure on ulcer healing drugs and endoscopies cost the NHS in excess of ££600 Million.4 Dyspepsia is common, with an incidence of 2 per 1000 population per year.5 Dyspepsia is also a lifelong, intermittent and relapsing disorder.
- Epigastric discomfort
- Fullness or bloating
- Excessive flatus
- Nausea
- Fatty food intolerance
Always ask about family history and medication use.
Also ask about "red flag symptoms" such as:
|
If investigated, patients with dyspeptic symptoms will prove to have either:
- Peptic ulcer disease (10%)
- Oesophagitis (15%)
- No significant abnormality (non-ulcer dyspepsia or functional dyspepsia - 75%)
Older patients are more likely to have serious disease.
- Always check for abdominal mass
- Also consider taking blood for FBC, so as to demonstrate another alarm feature i.e. iron deficiency anaemia.
- Peptic Ulcer
- Functional (non ulcer) dyspepsia
- Irritable Bowel syndrome
- Atypical GORD / GERD
- Biliary pain e.g. gallstones
- Achalasia
- Medication Induced
- Aerophagia
- Oesophageal spasm
- Carcinoma of oesophagus or stomach
Exclude abdominal mass and other causes of abdominal pain.
Urgent specialist referral - 2 week rule
If the patient has dyspepsia at any age with any of the following alarm symptoms:
|
For patients without alarm features and with previous investigations for dyspepsia
It is possible to treat on the basis that a similar pathology has recurred. Although refer to specialist if unresponsive to treatment or the diagnosis is in doubt.
|
For the uninvestigated patient without alarm features
The NICE guideline suggests the following steps:
|
If the patient responds to PPI but then relapses, consider low dose or intermittent treatment.
If there is no response consider a prokinetic e.g. metoclopramide or H2RA e.g. ranitidine for 1 month.
Where patients show an inadequate response to treatment consider other diagnoses e.g. gallstones and/or referral to a specialist.
See Also: Drugs used in Dyspepsia and Peptic Ulcer Disease.
Routine endoscopic investigation of dyspeptic patients is not necessary, but should be considered in patients over 55 where symptoms persist despite of H.pylori testing and acid suppression.4 However there has been some dissent over the NICE recommendations, citing the value of early detection of GI cancer and its improved survival rates.15
Patients with the following risk factors have a higher risk of malignancy and so lower your threshold for endoscopy referral:
|
Document references
- No authors listed; Management of dyspepsia: report of a working party. Lancet. 1988 Mar 12;1(8585):576-9.
- Talley NJ, et al; Functional dyspepsia: A classification with guidelines for diagnosis and management. Gastroenterol. Int. 1991 4:145-160.
- Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE. Rome II: The functional gastrointestinal disorders. Allen Press: Lawrence KS USA, 2000.
- Dyspepsia: Managing dyspepsia in adults in primary care, NICE (2004)
- McCormick A, Fleming D, Charlton J. Morbidity statistics from General Practice. Fourth national morbidity study 1991-1992. London: Office of Population Censuses and Surveys., 1995;
- Ryder SD, O'Reilly S, Miller RJ, et al; Long term acid suppressing treatment in general practice. BMJ. 1994 Mar 26;308(6932):827-30. [abstract]
- Jones RH, Lydeard SE, Hobbs FD, et al; Dyspepsia in England and Scotland. Gut. 1990 Apr;31(4):401-5. [abstract]
- Hansen JM, Bytzer P, Schaffalitzky De Muckadell OB; Management of dyspeptic patients in primary care. Value of the unaided clinical diagnosis and of dyspepsia subgrouping. Scand J Gastroenterol. 1998 Aug;33(8):799-805. [abstract]
- Talley NJ, Weaver AL, Tesmer DL, et al; Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy. Gastroenterology. 1993 Nov;105(5):1378-86. [abstract]
- Referral guidelines for suspected cancer, NICE (2005)
- Chiba N, De Gara CJ, Wilkinson JM, et al; Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology. 1997 Jun;112(6):1798-810. [abstract]
- Moayyedi P, Soo S, Deeks J, et al; Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD002096. [abstract]
- van Pinxteren B, Numans ME, Bonis PA, et al; Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2006 Jul 19;3:CD002095. [abstract]
- Moayyedi P, Soo S, Deeks J, et al; Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001960. [abstract]
- Griffin SM, Bowrey DJ, Allum WH. Upper gastrointestinal surgeons comment on NICE dyspepsia guidelines BMJ; February 5th, 2005
- Foy R, Parry JM, Murray L, et al; Testing for Helicobacter pylori in primary care: trouble in store? J Epidemiol Community Health. 1998 May;52(5):305-9. [abstract]
- Delaney BC, Moayyedi P, Forman D; Initial management strategies for dyspepsia. Cochrane Database Syst Rev. 2003;(2):CD001961. [abstract]
Internet and further reading
- PCSG: Primary Care Society for Gastroenterology.
- Digestive Disorders Foundation
- Dyspepsia - proven DU, GU, or NSAID-associated ulcer, Clinical Knowledge Summaries (2005)
DocID: 459
Document Version: 2
DocRef: bgp1656
Last Updated: 3 Jul 2007
Review Date: 2 Jul 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineInformation leaflets related to this topic (^ top of page)
Acid Reflux & Oesophagitis
Duodenal Ulcer
Dyspepsia - Functional or Non-Ulcer
Dyspepsia (Indigestion)
Helicobacter Pylori & Stomach Pain
Stomach (Gastric) UlcerMedical reference articles in PatientPlus related to this topic (^ top of page)
Antacids and Simeticone and Other Indigestion Remedies
Chest Pain
Drugs used in Dyspepsia and Peptic Ulcer Disease
Gastro-Oesophageal Reflux Disease
H2-Receptor Antagonists
Helicobacter Pylori (HP)
Peptic Ulcer Disease
Proton Pump Inhibitors
Ulcer Surgery and its ComplicationsUK guidelines related to this topic (^ top of page)
Guidelines on Dyspepsia
Guidelines on Peptic UlcerOnline videos related to this topic (^ top of page)
Online videos on Peptic UlcerLinks to other selected websites related to this topic (^ top of page)
Dyspepsia
Helicobacter Pylori
Indigestion
Peptic Ulcer
Ulcers (Peptic)Medicines related to this topic (^ top of page)
RanitidineOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Pharmacy products related to this topic (^ top of page)
Bisodol Tablets
Gavilast P Tablets
Gaviscon Advance Aniseed Flavour
Gaviscon Advance Peppermint Flavour
Gaviscon Cool Liquid
Gaviscon Cool Tablets
Gaviscon Double Action Liquid
Gaviscon Double Action Tablets
Gaviscon Liquid Aniseed
Gaviscon Liquid Peppermint
Gaviscon Liquid Sachets
Pepcidtwo Chewable Tablets
Pepto-Bismol Liquid Suspension
Ranzac75
Remegel Original
Rennie Deflatine Tablets
Rennie Dual Action Tablets
Rennie Fruit Formerly Rap-eze Assorted Tablets
Rennie Peppermint
Rennie SpearmintMedical equipment products related to this topic (^ top of page)
Pill/Tablet Equipment
Books related to this topic (^ top of page)
Indigestion and Ulcers (Understanding)
Indigestion and Ulcers : British Medical Association's Family Doctor Series
Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
