Intended for healthcare professionals

Clinical Review ABC of the upper gastrointestinal tract

Implications of dyspepsia for the NHS

BMJ 2001; 323 doi: (Published 22 September 2001) Cite this as: BMJ 2001;323:675
  1. Richard Logan,
  2. Brendan Delaney

    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.

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    Dyspepsia is not new and has been known throughout history (Indigestion by Cruickshank (1792-1872))

    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 patterns being common. Symptom patterns are not strong predictors of underlying disease. Recently it has been proposed that if heartburn or acid regurgitation are the dominant symptoms then these are sufficiently accurate predictors of gastro-oesophageal reflux to make a safe and accurate diagnosis (see next article). Fewer than a fifth of sufferers have this symptom pattern, and the predictive accuracy needs confirmation.


    Dyspepsia is common: in a recent UK survey 40% of adults reported having had one or more dyspeptic symptoms in the previous year, and about a half described these as being moderate to severe. Of this group, more than half were taking drugs for dyspepsia (40% of which were prescribed) and 22% had seen their general practitioner about dyspepsia in the previous year. Thus, 9% of all those interviewed reported consulting their doctor about dyspepsia in the previous year.

    “Alarm” symptoms in patients with dyspepsia suggesting possibility of malignant disease

    • Anaemia

    • Loss of weight

    • Anorexia

    • Recent onset of progressive symptoms (<3 months)

    • Melaena or haematemesis

    • Dysphagia

    Most dyspeptic patients have no clinically significant abnormalities on investigation. Up to 20% may have endoscopic reflux oesophagitis, and 15-20% may have peptic ulcer disease, including duodenitis. A declining proportion, currently around 2%, will have a gastric or oesophageal cancer, with other “alarm” symptoms such as dysphagia or weight loss usually …

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