Intended for healthcare professionals

Clinical Review


BMJ 2013; 347 doi: (Published 29 August 2013) Cite this as: BMJ 2013;347:f5059
  1. Alexander C Ford, senior lecturer and honorary consultant gastroenterologist12,
  2. Paul Moayyedi, chief of gastroenterology3
  1. 1Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK
  2. 2Leeds Institute of Biomedical and Clinical Sciences, Leeds University, Leeds, UK
  3. 3Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada
  1. Correspondence to: AC Ford alexf12399{at}

Summary points

  • Dyspepsia is common—about a fifth of people are affected at some point in their lives

  • The condition is chronic, with a relapsing and remitting nature

  • There is no evidence that dyspepsia adversely affects survival

  • In most patients, no cause for dyspepsia is detected at endoscopy

  • Gastro-oesophageal cancer is extremely rare in patients with dyspepsia who have no alarm symptoms

  • Most treatments are safe and well tolerated, but there is little evidence that they have any long term effect on the natural course of the disorder

Definitions of the term dyspepsia vary but generally describe pain or discomfort in the epigastric region. People with dyspepsia have a normal life expectancy,1 but symptoms impair quality of life,2 3 and affect productivity.4 Dyspepsia is estimated to cost the United Kingdom more than £1bn (€1.16bn; $1.55bn) annually,5 so it is important to manage the condition appropriately. We summarise recent systematic reviews, meta-analyses, and randomised controlled trials to provide the general reader with an update on how to deal with this disorder effectively.

Sources and selection criteria

We searched Medline, Embase, the Cochrane Database of Systematic Reviews, and Clinical Evidence online using the search term “dyspepsia”, as well as recent conference proceedings. We limited studies to those conducted in adults and focused on systematic reviews, meta-analyses, and high quality randomised controlled trials published during the past five years whenever possible.

What is dyspepsia and who gets it?

Dyspepsia is a symptomatic diagnosis. A variety of definitions have been proposed, but a reasonable working definition for the primary care doctor is epigastric pain or discomfort for at least three months, in a patient who does not report predominant heartburn or regurgitation (although these symptoms can be part of the overall symptom complex). Gastro-oesophageal reflux disease (GORD) becomes the more likely diagnosis if symptoms of heartburn or regurgitation predominate, although this is one of …

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