Dyspepsia

Symptoms

• Fullness, indigestion, bloating

• Upper abdominal discomfort

• Heartburn

• Note: Alarm symptoms (e.g., unintentional weight loss, anaemia, dysphagia) require urgent investigation

Differentials

Most Common:

• Gastritis: Alcohol, aspirin, steroids

• Peptic ulcer: NSAIDs, H. pylori (especially in patients with a household member with H. pylori)

• GORD

• Functional dyspepsia (no structural cause found, associated with visceral hypersensitivity)

Gastroparesis:

• Vagus nerve damage: diabetes, previous abdominal surgery

• Slow gastric emptying: opioids

Others:

• Gastric cancer

• IHD: constricting-type pain → consider until proven otherwise

• Oesophagitis/oesophageal cancer

• Cholecystitis

• Hepatitis

• IBS

• Chronic pancreatitis/coeliac disease (rarely presents with dyspepsia alone)

Note: Hypercalcaemia (e.g., in malignancy or primary hyperparathyroidism) can mimic dyspepsia symptoms

History

• Any heartburn/regurgitation → improves with milk/antacids (GORD)

• Radiation of pain to the back (pancreatitis)

• Vomiting:

  • Gastroparesis → occurs with recurrent upper abdominal pain

• Any association with diarrhoea/bowel changes (IBS)

• Alcohol intake

• OTC medications: NSAIDs, aspirin

• Family history of gastric cancer/weight loss

• Symptoms worsening with:

  • Exercise (IHD)

  • Fatty foods (cholecystitis)

• Assess proper chewing habits

• Alarm Symptoms: Unintentional weight loss, dysphagia, haematemesis, melaena, anaemia

Treatment

Lifestyle Measures:

• Avoid smoking, alcohol, and spicy/triggering foods

• Encourage smaller, frequent meals and eating slowly

Medications:

• Avoid aspirin/NSAIDs unless medically necessary

• Antacids/PPIs

Other Interventions:

• Relaxation therapies

• Weight loss (for GORD)

• Functional dyspepsia: symptom management

• Treat NSAID-induced ulcers for 4 weeks post-cessation

• Repeat urea breath test 4 weeks post-treatment (for H. pylori)

• Test and treat H. pylori in patients with confirmed dyspepsia, particularly in high-prevalence areas or those with recurrent symptoms

When to Refer:

• Persistent symptoms despite 8 weeks of PPI therapy

• Presence of alarm symptoms or suspicion of malignancy