Dyspepsia

Dyspepsia, commonly called indigestion, refers to uncomfortable or painful sensations centered in the upper abdomen. Core symptoms include postprandial fullness, early satiety, epigastric pain or burning, and sometimes belching or nausea. The syndrome is divided into functional dyspepsia, in which no structural cause is found after evaluation, and organic dyspepsia, arising from conditions such as gastritis, peptic ulcer disease, gastroesophageal reflux disease, biliary or pancreatic disease, or less commonly cancer.

Functional dyspepsia is the most frequent form. Its exact cause is not known but is thought to involve impaired gastric motility, visceral hypersensitivity, low-grade inflammation, altered gut-brain signaling, and psychosocial factors. Helicobacter pylori infection and NSAID use can contribute to symptoms in some patients even when structural disease is not evident.

Evaluation typically starts with history and physical examination. Alarm features such as weight loss, progressive dysphagia, persistent vomiting, GI bleeding, iron-deficiency anemia, or onset of new symptoms after age fifty warrant prompt endoscopy. Noninvasive testing for H. pylori may be performed in other patients, and eradication therapy is used if positive. Endoscopy is indicated if symptoms persist despite initial management or red flags are present.

Management involves identifying and treating any organic cause, testing and treating H. pylori if present, and often a trial of a proton pump inhibitor for several weeks. If responding, therapy can be continued or adjusted; if not, alternatives include switching acid suppression, adding prokinetics where appropriate, and addressing lifestyle factors. For functional dyspepsia, dietary modification, smoking cessation, weight management, and psychological therapies may help alongside pharmacologic treatment.

Prognosis varies; many cases are chronic or relapsing but are typically manageable with appropriate care.