II. Definitions
- Dyspepsia
- Chronic or recurrent Epigastric Pain, burning, early satiety or post-prandial fullness
- Functional Dyspepsia
- At least 1 month of Dyspepsia without underlying organic cause on upper endoscopy OR
- Dyspepsia for at least 3 months of the last 6 months with no signs of organic cause
III. Epidemiology
- Dyspepsia overall Prevalence: 30% of adults in U.S (with 70% of cases Functional Dyspepsia)
IV. Pathophysiology: Functional Dyspepsia
- Unclear etiology, however may be related to altered gastric motility (present in 70-80% of cases)
- Inflammatory and immune factors may also play a role
- Helicobacter Pylori often found in patients with Dyspepsia, but causality is not clear
V. Causes
VI. Symptoms
- Epigastric burning, pain or discomfort
- Early satiety
- Associated symptoms
- Abdominal Bloating (difficult to treat)
- Belching and Flatulence
- Nausea and Vomiting
- Halitosis
VII. Diagnosis: Rome IV Criteria for Functional Dyspepsia
- Symptoms for at least 3 months of the last 6 months
- No evidence for structural disease (including on upper endoscopy if performed) that could explain symptoms and
- Symptom criteria (at least one is present)
- Epigastric Pain or epigastric burning on at least 1 day per week
- Early satiety on at least 1 day per week
- Postprandial fullness on at least 3 days per week
- References
VIII. Associated Conditions: Functional Dyspepsia
- Mood Disorders (e.g. Anxiety Disorder, Major Depression)
- Gastroesophageal Reflux disease (up to 50% co-occurrence)
- Irritable Bowel Syndrome (up to 35% co-occurrence)
IX. Differential Diagnosis
- See Dyspepsia Causes
- See Medication Causes of Dyspepsia
- Functional Dyspepsia diagnosis assumes exclusion of organic cause
X. Approach: Step 1 - Consider differential Diagnosis
- See Dyspepsia Causes
- See Medication Causes of Dyspepsia
- Most common conditions in differential diagnosis
- Idiopathic (functional disorder) in 60% of cases
- Gastroesophageal Reflux disease (often comorbid)
- Peptic Ulcer Disease
- Pancreatitis
- Biliary pain (Cholelithiasis)
- Irritable Bowel Syndrome
- Symptoms relieved by Defecation
- Associated with change in stool frequency or form
- Consider serious underlying causes (e.g. malignancy, Acute Coronary Syndrome)
- Symptomatic therapy in the Emergency Department
- Antacid monotherapy (e.g. Maalox, Mylanta)
- As effective with less side effects than Lidocaine solutions ("GI Cocktail")
- Warren (2020) Acad Emerg Med 27(9): 905-9 +PMID: 32602148 [PubMed]
- Antacid monotherapy (e.g. Maalox, Mylanta)
- General Measures
XI. Approach: Step 2 - Upper Endoscopy for high risk patients
- See Dyspepsia Red Flags for Indications
- Perform early upper endoscopy for those with age >60 years with at least one month of symptoms
- Early endoscopy indications at younger ages (<60 years old)
- High risk groups (e.g. southeast asian descent)
- Use clinical judgment in referral (e.g. multiple red flag symptoms)
- Multiple Dyspepsia Red Flags
- A single isolated red flag in those under age cut-off only mildly increase risk
XII. Approach: Step 3 - Consider Helicobacter Pylori testing
- Indications
- Indicated BEFORE acid suppression therapy in patients under age 60 years old
- Lack of relief with empiric antisecretory therapy
- Undifferentiated Dyspepsia
- H. pylori treatment (when testing positive) does appear effective in Functional Dyspepsia
- Test and treat strategy (without endoscopy) is cost effective
- Reserve endoscopy for Dyspepsia Red Flags (see Dyspepsia Red Flags)
- Dyspepsia Red Flags include age >55 years old, Unexplained Weight Loss, Dysphagia
- Testing
- Protocol
- Treat with H. Pylori Management if positive
- Retest for cure if symptoms persist after treatment
XIII. Approach: Step 4 - Consider empiric antisecretory therapy (acid suppression)
- Timing
- Initial trial for 8 weeks
- Longterm antisecretory use is often needed
- Antisecretory Agents
- Proton Pump Inhibitor (e.g. Omeprazole)
- No advantage to high Proton Pump Inhibitor doses (e.g. double doses)
- Highly effective agents but at higher cost, and with increased risk
- Considered first-line (preferred agents) in Functional Dyspepsia
- Risk of C. difficile, Pneumonia, Osteoporosis, Chronic Kidney Disease with PPI use >12 months
- Meineche-Schmidt (2004) Am J Gastroenterol 99:1050 [PubMed]
- H2 Blocker (e.g. Ranitidine)
- Cost effective initial trial
- Some protocols recommend as initial agent and switching to Proton Pump Inhibitor if not effective
- Proton Pump Inhibitor (e.g. Omeprazole)
- Adjunctive medication options
- Metoclopramide (prokinetic agent)
- May offer benefit in Nonulcer Dyspepsia
- Risk of tardive diskinesia
- Metoclopramide (prokinetic agent)
- Ineffective Medications (avoid)
- Sucralfate offers no benefit in Nonulcer Dyspepsia
- Misoprostol offers no benefit in Nonulcer Dyspepsia
- Bismuth Subsalicylate is not recommended due to toxicity with longerterm use
XIV. Approach: Step 5 - Upper Endoscopy Indications (if not already done above)
- Incomplete relief with above management
XV. Approach: Step 6 - Alternative Therapies
-
Tricyclic Antidepressants
- Amitriptyline (Elavil) titrated to 25 mg nightly (may titrate to 75 mg nightly)
- Imipramine 50 mg nightly
- Ford (2017) Gut 66(3): 411-20 [PubMed]
- Other mental health agents and methods have not been shown consistently effective
- Selective Serotonin Reuptake Inhibitors (SSRI) have NOT shown benefit in Functional Dyspepsia
- Psychotherapy has not shown consistent benefit in Functional Dyspepsia
- Complimentary and Alternative Medicine (possibly effective agents in Functional Dyspepsia)
- Peppermint plus Caraway Oil
- Turmeric (Curcuma longa)
- Iberogast (STW 5)
- Rikkunshito (per American College Gastroenterology)
- Baez (2023) Cochrane Database Syst Rev (6): CD013323 [PubMed]
XVI. References
- Bazaldua (1999) Am Fam Physician 60(6):1773-84 [PubMed]
- Dickerson (2004) Am Fam Physician 70:107-14 [PubMed]
- Fisher (1998) N Engl J Med 339:1376-81 [PubMed]
- Laine (2001) An Intern Med 134:361-9 [PubMed]
- Loyd (2011) Am Fam Physician 83(5): 547-52 [PubMed]
- Moayyedi (2017) Am J Gastroenterol 112(7): 988-1013 [PubMed]
- Mounsey (2020) Am Fam Physician 101(2): 84-8 [PubMed]
- Richter (1991) Scand J Gastroenterol 182:11-6 [PubMed]
- Talley (2005) Am J Gastroenterol 10:2324-37 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSHCZE) | Zánět sliznice dvanáctníku (duodena). Mnohdy v souvislosti s infekcí bakterií Helicobacter pylori. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | Acute or chronic inflammation of the duodenum. Causes include bacterial and viral infections and gastroesophageal reflux disease. Symptoms include vomiting and abdominal pain. |
| Definition (NCI_NCI-GLOSS) | Inflammation of the duodenum (the first part of the small intestine that connects to the stomach). |
| Definition (MSH) | Inflammation of the DUODENUM section of the small intestine (INTESTINE, SMALL). Erosive duodenitis may cause bleeding in the UPPER GI TRACT and PEPTIC ULCER. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D004382 |
| ICD9 | 535.6 |
| ICD10 | K29.8 |
| SnomedCT | 155715004, 72007001 |
| French | DUODENITE, Duodénite |
| English | DUODENITIS, duodenitis, duodenitis (diagnosis), Duodenitis [Disease/Finding], Duodenitis, duodenitis nos, Duodenitis (disorder), duodenum; inflammation, inflammation; duodenum, Duodenitis, NOS |
| Portuguese | DUODENITE, Duodenite |
| Spanish | DUODENITIS, duodenitis (trastorno), duodenitis, inflamación del duodeno, Duodenitis |
| Swedish | Tolvfingertarmsinflammation |
| Japanese | ｼﾞｭｳﾆｼﾁｮｳｴﾝ, 十二指腸炎, 十二指腸カタル |
| Czech | duodenitida, zánět sliznice dvanáctníku, Duodenitida |
| Finnish | Duodeniitti |
| Russian | DUODENIT, ДУОДЕНИТ |
| German | DUENNDARMENTZUENDUNG, Duodenitis |
| Korean | 십이지장염 |
| Croatian | DUODENITIS |
| Polish | Zapalenie dwunastnicy |
| Hungarian | Duodenitis |
| Norwegian | Inflammasjon i tolvfingertarmen, Duodenitt, Betennelse i tolvfingertarmen |
| Dutch | duodenum; ontsteking, ontsteking; duodenum, duodenitis, Duodenitis |
| Italian | Duodenite |
Ontology: Dyspepsia (C0013395)
| Definition (MEDLINEPLUS) |
Nearly everyone has had indigestion at one time. It's a feeling of discomfort or a burning feeling in your upper abdomen. You may have heartburn or belch and feel bloated. You may also feel nauseated, or even throw up. You might get indigestion from eating too much or too fast, eating high-fat foods, or eating when you're stressed. Smoking, drinking too much alcohol, using some medicines, being tired, and having ongoing stress can also cause indigestion or make it worse. Sometimes the cause is a problem with the digestive tract, like an ulcer or GERD. Avoiding foods and situations that seem to cause it may help. Because indigestion can be a sign of a more serious problem, see your health care provider if it lasts for more than two weeks or if you have severe pain or other symptoms. Your health care provider may use x-rays, lab tests, and an upper endoscopy to diagnose the cause. You may need medicines to treat the symptoms. NIH: National Institute of Diabetes and Digestive and Kidney Diseases |
| Definition (NCI_CTCAE) | A disorder characterized by an uncomfortable, often painful feeling in the stomach, resulting from impaired digestion. Symptoms include burning stomach, bloating, heartburn, nausea and vomiting. |
| Definition (NCI_NCI-GLOSS) | Upset stomach. |
| Definition (NCI) | An uncomfortable, often painful feeling in the stomach, resulting from impaired digestion. Symptoms include burning stomach pain, bloating, heartburn, nausea, and vomiting. Causes include gastritis, gastric ulcer, gastroesophageal reflux disease, pancreatic disease, and gallbladder disease. |
| Definition (MSH) | Impaired digestion, especially after eating. |
| Concepts | Sign or Symptom (T184) |
| MSH | D004415 |
| ICD10 | K30 , R10.13 |
| SnomedCT | 266505001, 139299007, 249510006, 87548005, 155722007, 196752002, 162031009 |
| English | Indigestion, Dyspepsia, Dyspepsias, DYSPEPSIA, INDIGESTION, Indigestion NOS, dyspepsia (diagnosis), dyspepsia, Indigestions, Dyspepsia [Disease/Finding], indigestion, Dyspepsia/indigestion NOS, Indigestion NOS (finding), Dyspepsia (disorder), Dyspepsia, indigestion NOS, Indigestion (finding), Dyspepsia/indigestion, Dyspepsia, NOS, Indigestion, NOS, Dyspepsia (disorder) [Ambiguous] |
| French | DYSPEPSIE, INDIGESTION, Dyspepsie, Indigestion |
| Portuguese | DISPEPSIA, Indisgestão, INDIGESTAO, Dispepsia, Indigestão |
| Spanish | DISPEPSIA, INDIGESTION, indigestión, SAI (hallazgo), indigestión, SAI, dispepsia (trastorno), dispepsia (concepto no activo), dispepsia, indigestión (hallazgo), indigestión, Dispepsia, Indigestión |
| German | DYSPEPSIE, VERDAUUNGSBESCHWERDEN, Dyspepsie, Indigestion, Magenverstimmung, Verdorbener Magen, Verdauungsstörung |
| Dutch | indigestie, Indigestie/dyspepsie, dyspepsie, Dyspepsia, Dyspepsie, Indigestie |
| Swedish | Dyspepsi |
| Japanese | ｼｮｳｶｼｮｳｶﾞｲ, ｼｮｳｶﾌﾘｮｳ, 消化不良, 消化障害, 不消化, 消化不良症 |
| Czech | dyspepsie, Dyspepsie, Porucha trávení |
| Finnish | Dyspepsia |
| Russian | NESVARENIE, DISPEPSIIA, ДИСПЕПСИЯ, НЕСВАРЕНИЕ |
| Italian | Indigestione, Dispepsia |
| Korean | 소화불량 |
| Croatian | DISPEPSIJA |
| Polish | Zaburzenia trawienia, Dyspepsja, Niestrawność |
| Hungarian | Dyspepsia, Indigestio |
| Norwegian | Fordøyelsesbesvær, Dyspepsi |
Ontology: Gastritis (C0017152)
| Definition (MSHCZE) | Zánět žaludku. Akutní g. vzniká většinou jako součást infekce nebo následkem dietní chyby. Často je spojena i se střevními projevy (gastroenteritida). Bývá značná nevolnost, zvracení, průjmy. Jde o běžné onemocnění, někdy se však za podobnými příznaky mohou skrývat závažnější stavy. Srov. dyspepsie. Chronická g. je onemocnění, které lze zjistit jen histologicky (biopsie při gastroskopii). Nemá typické příznaky a může probíhat i zcela bezpříznakově. U chronické g. se rozlišuje několik typů. Typ A je autoimunitní g. spojená s achlorhydrií a ev. perniciózní anemií, uvádí se vyšší riziko vzniku nádoru. Typ B je antrální g. vznikající v souvislosti s infekcí H. pylori. Typ C se někdy uvádí jako chemická g. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | Inflammation of the stomach. |
| Definition (NCI_NCI-GLOSS) | Inflammation of the lining of the stomach. |
| Definition (NCI_CTCAE) | A disorder characterized by inflammation of the stomach. |
| Definition (CSP) | inflammation of the stomach. |
| Definition (MSH) | Inflammation of the GASTRIC MUCOSA, a lesion observed in a number of unrelated disorders. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D005756 |
| ICD10 | K29.7 |
| SnomedCT | 155711008, 235653009, 266503008, 196743006, 4556007 |
| English | Gastritides, Gastritis, GASTRIC INFLAMMATION, STOMACH INFLAMMATION, Gastritis unspecified, Gastritis, unspecified, gastritis, gastritis (diagnosis), Gastritis NOS, Inflammation stomach, Stomach inflammation, Gastritis [Disease/Finding], stomach inflammation, Inflammation;stomach, gastric inflammation, Gastritis unspecified (disorder), Already mapped above AAHA ID #: 832, Gastric inflammation, Stomach inflamed, Catarrhal gastritis, GASTRITIS, Gastric catarrh, Gastritis (disorder), Gastritis, NOS, Gastritis [Ambiguous], inflammation of the stomach |
| French | GASTRITE, Inflammation gastrique, Inflammation de l'estomac, Gastrite SAI, INFLAMMATION DE L'ESTOMAC, INFLAMMATION GASTRIQUE, Gastrite |
| Portuguese | GASTRITE, Inflamação gástrica, Inflamação do estômago, Gastrite NE, INFLAMACAO DO ESTOMAGO, INFLAMACAO GASTRICA, Gastrite |
| Spanish | GASTRITIS, Gastritis NEOM, Inflamación de estómago, Inflamación gástrica, Inflamación estomacal, ESTOMAGO INFLAMADO, GASTRICA, INFLAMACION, gastritis no especificada (trastorno), gastritis no especificada, catarro gástrico, gastritis (trastorno), gastritis, Gastritis |
| German | GASTRITIS, Magenentzuendung, Gastritis NNB, Entzuendung, Magen, Gastritis, nicht naeher bezeichnet, MAGENENTZUENDUNG, MAGENSCHLEIMHAUTENTZUENDUNG, Gastritis, Magenschleimhautentzündung |
| Dutch | gastritis NAO, maagontsteking, gastrische ontsteking, ontsteking maag, Gastritis, niet gespecificeerd, gastritis, Gastritis |
| Italian | Gastrite NAS, Infiammazione gastrica, Infiammazione dello stomaco, Gastrite |
| Japanese | 胃炎ＮＯＳ, 胃炎, 胃の炎症, ｲﾉｴﾝｼｮｳ, ｲｴﾝ, ｲｴﾝNOS |
| Swedish | Magkatarr |
| Czech | gastritida, zánět žaludeční sliznice, Zánět žaludku, Gastritida NOS, Gastritida |
| Finnish | Mahatulehdus |
| Russian | GASTRIT, ГАСТРИТ |
| Korean | 상세불명의 위염 |
| Croatian | GASTRITIS |
| Polish | Zapalenie żołądka, Nieżyt żołądka |
| Hungarian | Gastritis k.m.n., Gyomor gyulladása, Gastritis, Gastrikus gyulladás, Gyomorgyulladás |
| Norwegian | Gastritt, Magekatarr |
Ontology: Nonulcer dyspepsia (C0267167)
| Concepts | Finding (T033) |
| ICD10 | K30 |
| SnomedCT | 3696007 |
| English | FUNCTIONAL DYSPEPSIA, NUD (nonulcer dyspepsia), functional dyspepsia, gastric irritation, non ulcer dyspepsia, non-ulcer dyspepsia, nonulcer dyspepsia, dyspepsia functional, Nonulcer dyspepsia, Non ulcer dyspepsia, Functional dyspepsia, Non-ulcer dyspepsia, Nonulcer dyspepsia (disorder) |
| Dutch | dyspepsie niet ten gevolge van ulcus, functionele dyspepsie |
| French | Dyspepsie sans ulcère, Dyspepsie fonctionnelle |
| German | funktionelle Dyspepsie, Funktionelle Dyspepsie |
| Italian | Dispepsia non ulcerosa, Dispepsia funzionale |
| Portuguese | Dispepsia não ulcerosa, Dispepsia funcional |
| Spanish | Dispepsia funcional, Dispepsia no-ulcerosa, dispepsia funcional, dispepsia no ulcerosa (trastorno), dispepsia no ulcerosa |
| Japanese | 非潰瘍性消化不良, ﾋｶｲﾖｳｾｲｼｮｳｶﾌﾘｮｳ, 機能性ディスペプシア, ｷﾉｳｾｲﾃﾞｨｽﾍﾟﾌﾟｼｱ |
| Czech | Nevředovitá dyspepsie, Funkční dyspepsie |
| Hungarian | Nem-fekélyes dyspepsia, Funkcionális dyspepsia |
Ontology: Acid dyspepsia (C0857034)
| Concepts | Disease or Syndrome (T047) |
| Dutch | zure dyspepsie |
| French | Dyspepsie acide |
| German | saure Dyspepsie |
| Italian | Dispepsia acida |
| Portuguese | Dispepsia ácida |
| Spanish | Dispepsia ácida |
| Japanese | 胃酸過多性消化不良, ｲｻﾝｶﾀｾｲｼｮｳｶﾌﾘｮｳ |
| English | Acid dyspepsia |
| Czech | Dyspepsie |
| Hungarian | Sav dyspepsia |
