From the Guidelines
Red flag symptoms of dyspepsia that necessitate urgent medical attention include unintentional weight loss, persistent vomiting, difficulty swallowing, vomiting blood, black or tarry stools, severe or worsening abdominal pain, anemia, jaundice, and a palpable abdominal mass, as highlighted in the British Society of Gastroenterology guidelines 1. These symptoms are particularly concerning in patients over 55 years old or those with a family history of gastrointestinal cancers. The guidelines recommend that urgent endoscopy is only warranted in patients aged ≥55 years with dyspepsia with weight loss, or those aged >40 years from an area at an increased risk of gastric cancer or with a family history of gastro-oesophageal cancer 1. Key points to consider in the management of dyspepsia include:
- The importance of establishing an effective and empathic doctor–patient relationship and a shared understanding 1
- The need to explain the diagnosis of functional dyspepsia, its underlying pathophysiology, and the natural history of the condition to the patient 1
- The recommendation for non-invasive testing for Helicobacter pylori and eradication therapy if infected 1
- The consideration of urgent abdominal CT scanning in patients aged ≥60 years with abdominal pain and weight loss to exclude pancreatic cancer 1 It is crucial to recognize these red flag symptoms to ensure prompt referral for endoscopy and further investigation, rather than empiric treatment for dyspepsia, as early detection of serious conditions like gastrointestinal malignancies significantly improves treatment outcomes 1.
From the Research
Red Flag Symptoms of Dyspepsia
The following are considered red flag symptoms of dyspepsia:
- Patients over age 60 years 2
- Anemia 2
- Other alarm symptoms, such as those that may indicate a risk of gastric cancer, although these specific symptoms are not detailed in the provided studies, the presence of alarm symptoms is mentioned as a factor in determining the appropriate diagnostic approach 3
Evaluation and Diagnostic Approach
Evaluation of dyspepsia is driven by patient age and the presence of red-flag symptoms 2
- Patients with red-flag symptoms, such as those over age 60 or with anemia, should undergo esophagogastroduodenoscopy to rule out malignancy and other serious causes of dyspepsia 2
- Helicobacter pylori infection should be excluded in all patients with dyspepsia 2
Treatment and Management
Treatment options for dyspepsia include proton pump inhibitors, although the evidence supporting their use is weak, and the response rate is less than robust 2, 4
- Proton pump inhibitors have proven efficacy for the treatment of acid-related gastrointestinal disorders, but their use may be associated with significant complications 5