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.
|Dysphagia||Difficulty swallowing; food getting stuck.|
|Flatulence||Passing of gas.|
|Functional dyspepsia||Symptom without an anatomic correlate for pain; also known as "nonulcer" dyspepsia.|
|Gastroparesis||Hypoactive bowel activity; often associated with autonomic neuropathy of diabetes. Characterized by abdominal distention, bloating, nausea, and flatulence.|
|GERD||Gastroesophageal 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 value||The probability of not having the suspected disease when a particular symptom is absent.|
|NSAID||Nonsteroidal anti-inflammatory drug.|
|Organic dyspepsia||Dyspepsia associated with a specific diagnosis.|
|Positive likelihood ratio||The increase in odds for a particular diagnosis if a symptom or factor is present.|
|Positive predictive value||The probability of the suspected disease in a patient with a particular symptom.|
|Regurgitation||Reflux 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 ...