What is the definition of dyspepsia according to Nelson's 22nd edition?

Dyspepsia Definition According to Nelson's 22nd Edition

I cannot provide the specific definition from Nelson's 22nd edition as it is not included in the evidence provided. However, I can provide the current consensus definition from authoritative gastroenterology guidelines.

Standard Clinical Definition

Dyspepsia is defined as chronic or recurrent pain or discomfort centered in the upper abdomen (epigastrium), with symptoms that must be present for at least 3 months and have an onset at least 6 months prior to diagnosis. 1, 2

Core Symptom Components

The symptom complex of dyspepsia includes one or more of the following bothersome symptoms (severe enough to impact usual activities): 1, 3

• Bothersome epigastric pain (severe enough to impact usual activities) 1
• Bothersome epigastric burning (severe enough to impact usual activities) 1
• Bothersome postprandial fullness (severe enough to impact usual activities) 1
• Bothersome early satiation (severe enough to prevent finishing a regular-sized meal) 1

Additional associated symptoms may include postprandial bloating, belching, and nausea. 1

Critical Exclusion Criteria

Heartburn is NOT a dyspeptic symptom, though it may frequently coexist. 1, 3 Patients with predominant or frequent heartburn (more than once weekly) or acid regurgitation should be considered to have gastroesophageal reflux disease (GERD) until proven otherwise. 2, 4

The key distinction is identifying the predominant symptom: 4, 3

• If epigastric pain/burning/discomfort is predominant → treat as dyspepsia 4
• If heartburn/acid regurgitation is predominant and occurs >1x weekly → treat as GERD 4

Diagnostic Classification

After appropriate investigation (typically upper endoscopy), dyspepsia is classified as: 1, 5

• Functional dyspepsia: No structural or biochemical explanation found on endoscopy (accounts for ~80% of cases) 1
• Organic dyspepsia: Structural cause identified (peptic ulcer, erosive esophagitis, malignancy) 5

Rome IV Functional Dyspepsia Subtypes

Functional dyspepsia is further subdivided into: 1, 3

Epigastric Pain Syndrome (EPS)

Must include one or both symptoms at least 1 day per week: 1, 3

• Bothersome epigastric pain
• Bothersome epigastric burning

Postprandial Distress Syndrome (PDS)

Must include one or both symptoms at least 3 days per week: 1, 3

• Bothersome postprandial fullness
• Bothersome early satiation

Important Clinical Pitfalls

Symptom overlap is common: 63-66% of patients with heartburn also have coexisting epigastric pain, and 19% of patients cannot identify their predominant symptom. 3 This makes clinical differentiation challenging but essential for appropriate management. 4

Symptoms relieved by defecation or passage of gas should generally not be considered part of dyspepsia, as these suggest irritable bowel syndrome. 1

Persistent vomiting suggests another disorder and warrants further investigation rather than a diagnosis of functional dyspepsia. 1, 3