Dyspepsia (Indigestion)
(Am J Gastroenterol. 2005;100:2324-37; Gastroenterology. 1998;114:579-81 & 582-95)
DEFINITION:
Chronic or recurrent pain or discomfort centered in upper abdomen
Patients with predominant or frequent (>once/week) heartburn should be considered to have GERD until proven otherwise
Functional Dyspepsia:
Chronic or recurrent pain or discomfort centered in upper abdomen without endoscopic or other test evidence of disease
EPIDEMIOLOGY:
ETIOLOGIES:
GERD (characteristic heartburn)
Organic: PUD (15-20%), gastric cancer (<3%)
Other: lactose intolerance, biliary (cholelithiasis, cholecystitis, colic), mesenteric ischemia, chronic pancreatitis
Functional (‘non-ulcer dyspepsia’ or NUD, ˜60%):
? delayed gastric emptying, ↓ fundic accommodation, gastric dysrythmias, visceral (afferent) hypersensitivity, IBS, Brain/Gut (psych)
Complete DDX:
Abdominal wall pain, Biliary pain/Liver disease, Chronic pancreatitis, Small bowel pathology (chronic mesenteric ischemia), Colonic (transverse) pathology, Diabetic radiculopathy, Thyroid, Electrolyte abnormalities (calcium, heavy metal), Porphyria, Familial Mediterranean Fever, Eosinophilic gastritis, Connective tissue diseaseRelated posts:
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