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ULY CLINIC

ULY CLINIC

9 Septemba 2025, 04:37:33

Dyspepsia

Dyspepsia
Dyspepsia
Dyspepsia
Comprehensive Clinical Review for Health Professionals

Dyspepsia is a symptom complex involving epigastric pain or discomfort lasting ≥1 month, often associated with:

  • Postprandial fullness

  • Early satiety

  • Nausea ± vomiting

  • Upper abdominal bloating

  • Belching

  • Heartburn (sometimes overlaps with GERD)

Important: Dyspepsia is not a disease, but a clinical syndrome resulting from functional disorders or organic pathology.


Epidemiology

Parameter

Details

Global prevalence

20–40%

Functional dyspepsia

60–70% of cases

Organic causes

30–40% (Peptic ulcer, GERD, cancer)

Peak age

20–50 years

Gender

Slight female predominance


Pathophysiology

Mechanisms

  • Functional dyspepsia: Impaired gastric accommodation, delayed gastric emptying, visceral hypersensitivity, altered gut-brain axis.

  • Organic causes: Mucosal injury (H. pylori, NSAIDs), acid hypersecretion, inflammation, neoplasia.

  • Psychosocial factors: Anxiety, depression worsen symptoms.


Comprehensive causes of Dyspepsia


1. Gastrointestinal causes

Category

Examples

Peptic ulcer disease

Gastric ulcer, duodenal ulcer

GERD

Acid reflux, hiatal hernia

Gastritis

H. pylori, autoimmune, chemical (NSAIDs, alcohol)

Gastric malignancy

Adenocarcinoma, lymphoma

Esophageal disorders

Achalasia, strictures, cancer


2. Hepatobiliary and pancreatic causes

Condition

Key Features

Cholelithiasis

RUQ pain radiating to back

Cholecystitis

Fever, Murphy’s sign

Choledocholithiasis

Jaundice, biliary colic

Hepatitis

Malaise, jaundice

Pancreatitis

Severe epigastric pain radiating to back

Pancreatic cancer

Weight loss, jaundice


3. Systemic & metabolic disorders

Condition

Clues

Diabetes (autonomic neuropathy)

Gastroparesis, nausea

Hypothyroidism

Constipation, fatigue

Hypercalcemia

Polyuria, constipation

Chronic renal failure

Uremic symptoms

Cardiac ischemia

Atypical epigastric pain in elderly


4. Infectious causes

  • H. pylori infection

  • Viral hepatitis

  • Parasitic infections (Giardia, Strongyloides)


5. Medication-induced

Drug Class

Examples

NSAIDs

Aspirin, Ibuprofen

Steroids

Prednisone

Antibiotics

Macrolides, Metronidazole

Chemotherapy

Cisplatin

Others

Iron, Bisphosphonates, Opiates


6. Functional dyspepsia

  • Diagnosis of exclusion

  • Rome IV criteria:

    • Postprandial distress syndrome (PDS): Post-meal fullness, early satiety

    • Epigastric pain syndrome (EPS): Intermittent epigastric pain/burning


7. Psychosocial and psychiatric factors

  • Depression

  • Anxiety disorders

  • Somatization disorder


Alarm features

Red Flag

Possible Diagnosis

Weight loss

Malignancy

Dysphagia

Esophageal/gastric cancer

Persistent vomiting

Gastric outlet obstruction

GI bleeding

Ulcer, cancer


Diagnostic workup

  • CBC, ESR/CRP

  • LFTs, renal function, glucose, calcium

  • H. pylori testing (urea breath test, stool antigen)

  • Upper endoscopy for >50 years or alarm symptoms

  • ECG if cardiac etiology suspected


Treatment

  • Lifestyle: Avoid alcohol, NSAIDs, caffeine

  • Empirical PPI: 4–8 weeks if no alarm signs

  • H. pylori eradication: PPI + clarithromycin + amoxicillin/metronidazole

  • Prokinetics: Metoclopramide, domperidone

  • Psychotropic agents: Low-dose TCA for functional dyspepsia


Special populations

  • Elderly: Higher malignancy risk → early endoscopy

  • Pregnant women: Avoid PPIs unless necessary; use antacids

  • Comorbid patients: Modify drug therapy to avoid GI irritation


Patient counseling

  • Educate about chronic nature and triggers

  • Emphasize medication adherence

  • Recognize red flags needing urgent care

References

  1. Moayyedi P, et al. ACG/CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017.

  2. Talley NJ, Ford AC. Functional dyspepsia. N Engl J Med. 2015.

  3. NICE Guidelines: Dyspepsia and Gastro-Oesophageal Reflux Disease (2021).


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