Patient Guide

Dyspepsia

Worldwide, dyspepsia is common, with an estimated prevalence of 25 to 50 percent in Western countries and approximately 15 to 30 percent in Asian countries including Korea and Singapore. 

Geographic variations in the prevalence of dyspepsia are partly due to the definition of dyspepsia and partly a result of the heterogeneity of symptoms that may or may not indicate an identifiable upper gastrointestinal (GI) disease.

Dyspepsia can be defined as a symptom complex of epigastric pain or discomfort which originates in the upper GI tract. It includes symptoms of bloating, early satiety and sensation of indigestion. Other symptoms suggestive of gastro-oesophageal reflux disease (GERD) such as burping and heart burn, though may be present, are usually not the predominant complaints.

Dyspepsia is a clinical diagnosis based on symptoms that may indicate specific conditions, such as gastritis, peptic ulcer disease or esophagitis. In the absence of an identifiable cause especially after an upper endoscopy without any significant finding, the patient is considered to have functional dyspepsia or non-ulcer dyspepsia.

Of the conditions which present as dyspepsia, gastric cancer is probably the most important not to be missed. Besides age and genetic factors such as ethnic origin and family history, alarm features such as anaemia, unexplained weight loss, black stools, persistent vomiting or difficulty in swallowing strongly suggest complications and an early upper endoscopy is recommended.

Another common and important condition which presents as dyspepsia is peptic ulcer disease. This includes both gastric and duodenal ulcers found during endoscopy. Majority of these ulcers are the result of long term medication such as aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) and Helicobacter Pylori (HP) infection. Avoiding or eradicating these risk factors will reduce the ulcer relapse rate significantly.

Therapy for dyspepsia is dependent on the actual diagnosis and the presence or absence of complications. Common treatment regimes include the use of acid suppression medicine such as H2-blockers or proton pump inhibitors. Antibiotics are also commonly prescribed for eradicating HP infection. Simple over the counter medicine such as antacids and dietary regulation can also be effective for milder conditions. For patients with non-ulcer dyspepsia, medicine that regulates gut motility may be effective in reducing the discomfort.

The follow-up strategy is again dependent on the final diagnosis. Repeat endoscopy may be needed for patients diagnosed with gastric ulcer disease to document healing and clearance of HP infection. Most patients with non-ulcer dyspepsia do well on therapy which is driven by symptoms without the need for repeat endoscopy.

Contact consultant 6357 3766/7

Related clinics