Implications of dyspepsia for the NHS

There is no precise definition of dyspepsia. It can be defined pragmatically as upper abdominal or retrosternal pain, with or without other symptoms thought to be arising from the upper gastrointestinal tract which is the approach that has been generally adopted by epidemiological studies. It has been suggested that dyspeptic symptoms can be categorised as ulcer-like, reflux-like, and dysmotility-like as a guide to the underlying cause. These groups, however, overlap considerably, with mixed...

Strategies for managing dyspepsia in primary care

Initial empiric treatment with antacids or anti-secretory drugs A period of empiric treatment with antacids or H2 receptor antagonists has been the traditional strategy for managing patients with dyspepsia first consulting their doctor. This strategy recognises that most patients' symptoms are episodic and remit spontaneously and that the risk of peptic ulcer bleeding or perforation is extremely low. It also assumes that early diagnosis in the rare patient with malignant disease and no alarm...

Gastrooesophageal reflux disease

It is important and practical to distinguish gastro-oesophageal reflux disease (GORD) from dyspepsia. Frequent heartburn is a cardinal symptom of GORD acid reflux causes a retrosternal or epigastric burning feeling that characteristically radiates up towards the throat, is relieved transiently by antacids, and is precipitated by a meal or by lying down. Up to 60 of people with upper gastrointestinal symptoms report both heartburn and epigastric pain or discomfort. This overlap can be confusing,...

Oesophagus Heartburn

Gastro-oesophageal reflux disease (GORD) is defined as symptoms or mucosal damage (oesophagitis) resulting from the exposure of the distal oesophagus to refluxed gastric contents. However, the symptoms of reflux oesophagitis do not equate with mucosal damage, and patients with endoscopic evidence of oesophagitis do not necessarily have the worst symptoms. In primary care GORD is therefore best thought of in terms of symptoms symptom control is the aim of most management strategies, and indeed...

Box 13 Causes of dyspepsia

Findings from endoscopy in 2659 patients aged > 40 years consulting their doctor for dyspepsia for the first time Hiatus hernia or oesophagitis 19 Gastric or oesophageal cancer 3 Normal (including gastritis only) 59 Figure 1.4 Symptoms of dyspepsia reported by UK adults over the previous year Figure 1.4 Symptoms of dyspepsia reported by UK adults over the previous year Implications of dyspepsia for the NHS A recent Cochrane review has shown that initial endoscopy maybe associated with a 15...

Limitations of gastrointestinal symptoms

Many studies have shown that diagnosis from individual gastrointestinal symptoms alone is difficult. Obviously different diseases do have a different spectrum of symptoms. Thus patients with gastric cancer frequently complain of profound anorexia, weight loss, and nausea while those with alcohol related dyspepsia typically vomit and retch especially first thing in the morning. Other differences that stand out include the frequent use of psychotropic drugs in functional dyspepsia and the high...

Invasive tests

H pylori can be detected at endoscopy by histology, culture, or urease tests, each with inherent advantages and disadvantages. All these biopsy based methods for detecting Hpylori are liable to sampling error because infection is patchy. Up to 14 of infected patients do not have antral infection but have Hpylori elsewhere in the stomach, especially if they have gastric atrophy, intestinal metaplasia, or bile reflux. In addition, after partially effective eradication treatment, low levels of...

Indigestion When is it functional

Nicholas J Talley, Nghi Phung, Jamshid S Kalantar Patients often complain of indigestion, but what do they mean Indigestion is an old English word that means lack of adequate digestion, but patients and doctors interpret this in different ways. Many patients mean heartburn or acid regurgitation, the classic symptoms of gastro-oesophageal reflux disease. Some describe belching, abdominal rumblings, or even bad breath as indigestion. Others mean pain localised to the epigastrium or a non-painful...

Hypersecretion in duodenal ulcer disease

Before the discovery of Hpylori it was known that patients with duodenal ulcers secrete about twice as much acid as controls because they have twice as many parietal cells. Patients with gastric ulcer and those with functional dyspepsia have normal acid output and parietal cell count. Thus there was good evidence that acid played a major role in ulcer formation. Duodenal ulcers did not occur in achlorhydric people or in those secreting < 15 mmol h of acid. Duodenal ulcers can be healed, but...