What is dyspepsia?
Dyspepsia is a general term used to describe discomfort or pain in the upper abdomen. It can be called indigestion, sometimes it settles quite quickly but sometimes it can be more persistent. Other symptoms that may also develop are belching, quickly feeling full after eating and nausea.
This is sometimes called functional dyspepsia. It means that no clear underlying cause can be identified for the symptoms. The symptoms of dyspepsia can be caused by an ulcer in the stomach or duodenum, inflammation of the oesophagus and gastritis. The majority of people with dyspepsia do not have any of these findings, hence the term non-ulcer dyspepsia.
What causes dyspepsia?
The symptoms seem to arise from the upper gut, but the cause remains unclear. One theory is that the sensation in the stomach or small bowel may be altered. Other theories are that there is a delay in the emptying of the stomach.
Helicobacter Pylori (h.pylori) infection is thought to cause dyspepsia in some patients; however, many patients with this bacterium have no symptoms. Eradication of h.pylori does seem to improve symptoms in some patients with dyspepsia and therefore should be eradicated if present.
Medications can cause dyspepsia; common culprits are anti-inflammatory medicines, antibiotics and steroids.
What test may be done?
Non-ulcer dyspepsia is a diagnosis that is made only when no other cause can be identified. In some cases you may require to do a stool test to check for the presence of h.pylori. In some cases you may have a gastroscopy/ OGD (see link).
Treatment for non-ulcer dyspepsia?
If you have confirmed h.pylori infection, then this should be eradicated. Eradication comprises of two antibiotics and a proton pump inhibitor (PPI).
Reassurance and explanation of the condition. If an endoscopy is normal this can allay symptoms and anxiety.
Acid suppression therapy – a 4-6 week trial of acid suppression therapy with either PPI e.g. omeprazole, or H2-receptor antagonist e.g. ranitidine can improve symptoms by decreasing the amount of acid produced by the stomach.
Lifestyle changes: Dietary change: symptoms can be made worse by spicy foods, chilli, peppers, citrus fruits, fried food and chocolate. Alcohol and smoking also can make symptoms worse.
Medications: some medications can make symptoms worse; therefore, this can be evaluated at your consultation.
Rome Criteria for dyspepsia
One or more of the following:
Bothersome postprandial fullness
Bothersome early satiation
Bothersome epigastric pain
Bothersome epigastric burning
No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
*Must fulfill criteria for B1a. PDS and/or B1b. EPS
**Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis