Some Causes of Dyspepsia
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Cancer (eg, esophageal, gastric) | Chronic, vague discomfort Later, dysphagia (esophageal) or early satiety (gastric) Weight loss | Upper endoscopy Abdominal CT |
Change in bowel habits (eg, diarrhea, steatorrhea, bloating) Unexplained iron deficiency anemia | Serologic testing Small bowel biopsy | |
Symptoms described as gas or indigestion rather than chest pain by some patients May have exertional component Cardiac risk factors | ECG Serum cardiac markers Sometimes stress testing | |
Delayed gastric emptying (caused by diabetes, viral illness, or medications) | Nausea, bloating, fullness | Scintigraphic test of gastric emptying |
Medications (eg, bisphosphonates, erythromycin and other macrolide antibiotics, estrogens, iron,NSAIDs, opioids, potassium) | Use apparent on history Symptoms coincident with use | Clinical evaluation |
Reflux symptoms do not respond to acid-suppression therapy | Upper endoscopy with biopsy | |
Substernal chest pain with or without dysphagia for liquids and solids | Barium swallow Esophageal manometry | |
Heartburn Sometimes reflux of acid or stomach contents into mouth Symptoms sometimes triggered by lying down Relief with antacids | Clinical evaluation Sometimes endoscopy Sometimes esophageal pH monitoring | |
Burning or gnawing pain, may be relieved by food or antacids Risk factors: NSAID use, smoking, alcohol use, Helicobacter pylori infection | Upper endoscopy with H. pylori testing Trial of NSAID avoidance | |
NSAID = nonsteroidal anti-inflammatory drug. | ||