What is Dyspepsia?
Dyspepsia is chronic or recurrent pain or discomfort centered in the upper abdomen, characterized by cardinal symptoms of epigastric pain, epigastric burning, postprandial fullness, or early satiation. 1
Core Symptoms
The most recent British Society of Gastroenterology guidelines (2022) define dyspepsia by these cardinal symptoms 1:
- Epigastric pain or burning - discomfort in the upper central abdomen 1
- Postprandial fullness - persistent sensation of fullness after meals 1
- Early satiation - feeling full during meal ingestion that terminates eating 1
Additional symptoms that can be present include 1:
- Belching (upper GI gas expulsion)
- Nausea
- Upper abdominal bloating
What Dyspepsia Is NOT
Heartburn alone is not dyspepsia, though it can coexist. 1 Patients with predominant or frequent heartburn (occurring more than once weekly) or acid regurgitation should be considered to have GERD until proven otherwise, not dyspepsia. 1
Vomiting is atypical for dyspepsia and should prompt consideration of another disorder. 1
Symptoms relieved by bowel movements or passing gas suggest irritable bowel syndrome, not dyspepsia. 2
Clinical Classification
After investigation, dyspepsia is classified into two categories 1:
Organic (Structural) Dyspepsia
When a structural abnormality explains the symptoms 1:
- Peptic ulcer disease (responsible for ~10% of cases) 1
- Gastric or esophageal cancer 3
- Pancreatic or biliary disorders 3
Functional Dyspepsia (FD)
When no structural abnormality is found on endoscopy (accounts for ~80% of dyspepsia cases). 1 The Rome IV criteria subdivide FD into 1:
- Epigastric Pain Syndrome (EPS): Epigastric pain or burning present regardless of meals, occurring at least once weekly 1
- Postprandial Distress Syndrome (PDS): Early satiation and postprandial fullness triggered by meals, occurring at least three times weekly 1
Important caveat: Many patients have overlapping features of both subtypes, particularly in secondary and tertiary care. 1
Distinguishing from GERD in Practice
The American Gastroenterological Association recommends asking patients to identify their predominant symptom 4:
- If heartburn or acid regurgitation is predominant and occurs >1x/week → treat as GERD 4
- If epigastric pain, burning, or discomfort is predominant → treat as dyspepsia 4
Common pitfall: 63-66% of patients with heartburn also have coexisting epigastric pain, and 19% cannot identify a predominant symptom. 4 In these cases, focus treatment on the most bothersome symptom.
Prevalence and Impact
Dyspepsia affects approximately 20-25% of the Western population annually, making it responsible for about 10% of general practitioner workload. 1, 3