DYSPEPSIA

Upper abdominal discomfort arising from the upper gastrointestinal tract usually lasting more than 2–4 weeks.

Causes

  • Peptic ulcer disease
  • Gastroesophageal reflux disease (GERD)
  • Functional dyspepsia
  • Gastric or oesophageal cancer
  • Oesophagitis (drugs, candida, and others)
  • Gastroparesis or gastric outlet obstruction
  • Other motility disorders

Clinical features

  • Epigastric pain or discomfort, heartburn
  • Bloating , early satiety and/or fullness after meals
  • Repeated belching or regurgitation (often rumination)
  • Nausea

Dyspepsia alarm features: requires endoscopy

  • Dysphagia
  • Odynophagia (among patients who are HIV negative)
  • Weight loss
  • Abdominal mass or cervical lymphadenopathy
  • Evidence of upper GI bleeding
  • Iron deficiency anaemia
  • Recurrent vomiting
  • Recent dyspeptic symptoms or new dyspepsia in individuals over the age of 40 years

Other indications for endoscopy

  • History of long term smoking and alcohol misuse
  • Persistent dyspepsia despite appropriate treatment (e.g Proton-pump inhibitors in GERD)
  • Hepatobiliary disease