Chapter 4 DYSPEPSIA AND FUNCTIONAL DYSPEPSIA
The definition of dyspepsia is controversial, with some authorities including reflux symptoms whereas others do not. An international committee of clinical investigators that meets in Rome have routinely excluded reflux symptoms.
Dyspepsia has historically been defined as pain or discomfort located in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium). Discomfort may include bloating, fullness, early satiety, postprandial fullness or nausea. Dyspepsia may be either organic, implying an organic, systemic or metabolic disease has been identified as the cause, or functional, where there is no identifiable explanation for the symptoms. Functional dyspepsia is also known as idiopathic or non-ulcer dyspepsia.
The Rome III committee has redefined functional dyspepsia and limited the term to refer to the four following symptoms: bothersome post-prandial fullness, early satiation, epigastric pain, or epigastric burning. The remaining symptoms of discomfort listed above have been allocated clinical entities of their own, and together they comprise the functional gastroduodenal disorders (Table 4.1). In addition, as shown in Table 4.2, there are two new diagnostic categories within functional dyspepsia; namely postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS).
• Nausea and vomiting disorders
|Diagnostic criteria*for postprandial distress syndrome|
|Must include one or both of the following:|
1. Bothersome postprandial fullness, occurring after ordinary sized meals, at least several times per week
|Diagnostic criteria*for epigastric pain syndrome|
|Must include all of the following:|
1. Pain or burning localised to the epigastrium of at least moderate severity at least once per week
There is some overlap between symptoms of gastro-oesophageal reflux disease (GORD) and dyspepsia. Heartburn is traditionally excluded from the Rome II and III criteria for dyspepsia, although in Rome III a burning sensation confined to the epigastrium is not considered to be heartburn unless it also radiates retrosternally. Despite the exclusion of heartburn, reflux oesophagitis is the most common structural finding when patients with dyspepsia are evaluated by upper endoscopy in Western nations. Heartburn more than twice weekly strongly suggests GORD in favour of dyspepsia.
Uninvestigated dyspepsia refers to new onset or recurrent dyspepsia for which no diagnostic investigations have yet been performed and subsequently a specific diagnosis has not been reached. This has implications for both diagnostic and management pathways.
The prevalence of dyspepsia in the Western society is approximately 25%, although the true prevalence depends on the population being studied. The annual incidence is cited between 1% and 10%. As similar numbers of patients experience resolution of their symptoms, fairly constant prevalence rates occur. Women suffer marginally more than men and symptoms tend to improve slightly with age.
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