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A 40-year-old woman presents with 3 months of vague abdominal discomfort. It is predominantly epigastric in location but is often accompanied by a sense of "fullness" that makes it difficult for her to eat. Over the past few weeks, she has also noted a burning sensation in her upper abdomen and reports increased abdominal bloating, as well as postprandial nausea.

  • What additional questions would be important to ask to clarify the cause of her dyspepsia?
  • How do you classify dyspepsia?
  • What historical features or symptoms would prompt concern for a serious diagnosis?
  • How can the history help you distinguish between the various types of dyspepsia?

Dyspepsia is a general term that refers to symptoms originating from the upper gastrointestinal tract. As such, it may encompass a variety of symptoms. Typically, patients will describe epigastric pain but may also complain of heartburn, nausea, vomiting, abdominal distention, heartburn, early satiety, and anorexia. The condition occurs in approximately 25% to 40% of the population, with a range of 13% to 40%, although the majority of patients do not seek medical care.1,2 Dyspepsia is responsible for 2% to 5% of visits to a primary care physician3 and accounts for 40% to 70% of gastrointestinal complaints in general practice.4 An organic cause is found in 40% to 50% of cases, most often gastric ulcer, gastroesophageal reflux disease, and gastric cancer, but in approximately 50% of cases, no cause is found, and the patient is deemed to have functional or "nonulcer" dyspepsia.3 The approach to a dyspeptic patient should be 2-fold: attempting to elicit a symptom complex that may be helpful in diagnosing a specific condition and excluding worrisome or "alarm" symptoms.

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DysphagiaDifficulty swallowing; food getting stuck.
FlatulencePassing of gas.
Functional dyspepsiaSymptom without an anatomic correlate for pain; also known as "nonulcer" dyspepsia.
GastroparesisHypoactive bowel activity; often associated with autonomic neuropathy of diabetes. Characterized by abdominal distention, bloating, nausea, and flatulence.
GERDGastroesophageal reflux disease.
Irritable bowel syndrome (IBS)Abdominal pain or discomfort associated with change in stool frequency or consistency and often relieved by defecation.
Negative predictive valueThe probability of not having the suspected disease when a particular symptom is absent.
NSAIDNonsteroidal anti-inflammatory drug.
Organic dyspepsiaDyspepsia associated with a specific diagnosis.
Positive likelihood ratioThe increase in odds for a particular diagnosis if a symptom or factor is present.
Positive predictive valueThe probability of the suspected disease in a patient with a particular symptom.
RegurgitationReflux of gastrointestinal contents into the esophagus or mouth, or both.

The cause of dyspepsia proves to be benign in most patients. The most common diagnoses among patients who have undergone endoscopy include functional dyspepsia (prevalence approximating 50%), peptic ulcer disease (10%), esophagitis (20%), endoscopy-negative reflux disease (20%), and gastric or esophageal cancer (1%).5 The prevalence of a particular condition varies depending on the ...

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