Dyspepsia overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dyspepsia (from the Greek "δυς-" (Dys-), meaning hard or difficult, and "πέψη" (Pepse), meaning digestion) is chronic or recurrent pain or discomfort centered in the upper abdomen Discomfort, in this context, includes mild pain, upper abdominal fullness and feeling full earlier than expected with eating. It can be accompanied by bloating, belching, nausea or heartburn. Heartburn is excluded from the definition of dyspesia in ICD 10, as it usually has a different cause and management pathway. Many people get dyspepsia. It is often caused by lifestyle factors, such as smoking and diet, but there are some serious causes such as cancer of the stomach, peptic ulcer disease and some medications. When people have dyspepsia but no risk factors for any of the serious causes, it can be labeled undifferentiated dyspepsia and treated without further investigations. When people have been investigated for dyspepsia but no cause has been found it can be labeled as functional dyspepsia.

Historical Perspective

The current understanding of the pathogenesis of dyspepsia began with the first description of gastric ulcer disease in 1799. The term was first used in its current form in 1916 by Walter Alvarez.

Classification

Dyspepsia is broadly classified into two major types: ulcer and non-ulcer dyspepsia. The latter is also known as functional dyspepsia.

Pathophysiology

The symptoms of functional dyspepsia are directly caused by two major pathophysiological abnormalities abnormal gastric motility and visceral hypersensitivity.These mechanisms occur in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle.

Treatment

Medical Therapy

Functional and undifferentiated dyspepsia have similar treatments. Decisions around the use of drug therapy are difficult because trials included heartburn in the definition of dyspepsia. This led to the results favoring proton pump inhibitors (PPIs), which are questionably effective for the treatment of heartburn.