Dyspepsia is not the name of a disease on its own; it is the term describing a group of complaints arising from the stomach and the upper abdomen. In everyday speech it is mostly called “indigestion”.
A person with dyspepsia may have a particular underlying condition, or the investigations may find no structural disease that explains the complaints. In the second case, if the appropriate criteria are met, functional dyspepsia may be in question.
What are the symptoms of dyspepsia?
When dyspepsia is spoken of, these complaints are to the fore in particular:
- Fullness after meals: feeling uncomfortably full for a long time after eating
- Early satiety: feeling full before finishing a normal meal
- Epigastric pain: pain in the upper middle part of the abdomen, in the stomach area
- Epigastric burning: a burning sensation in the same area
Nausea, belching and bloating in the upper abdomen can also accompany them.
Are dyspepsia and “heartburn” the same thing?
Not exactly.
Patients saying “my stomach is burning” may be describing different areas. The epigastric burning of dyspepsia is felt in the upper abdomen, below the breastbone.
Burning that rises upwards from behind the breastbone is more related to gastro-oesophageal reflux.
Both can be present in the same person.
What causes dyspepsia?
Dyspepsia can have many causes. Some of them:
- Functional dyspepsia
- Peptic ulcer
- Helicobacter pylori infection
- Gastritis and gastropathy
- Medicines such as aspirin and certain painkillers
- Gastro-oesophageal reflux
- Gastroparesis
Less often, conditions of the pancreas, the bile ducts or other parts of the upper gastrointestinal tract can produce similar complaints.
It is therefore not correct to say “dyspepsia = gastritis”.
Can Helicobacter pylori cause dyspepsia?
Yes. H. pylori infection can be related to dyspeptic complaints.
Taking into account the patient’s age, characteristics and the frequency of the infection in their population, H. pylori can be looked for in suitable patients. Where an active infection is found, eradication treatment is given.
Are dyspepsia and functional dyspepsia the same thing?
No. This distinction matters.
Dyspepsia is a group of complaints. It describes symptoms such as early satiety, fullness after meals, or epigastric pain and burning.
Functional dyspepsia is a diagnosis. It is used in patients in whom appropriate assessment finds no structural disease explaining the complaints and who meet the diagnostic criteria.
In brief:
Dyspepsia = a group of symptoms
Functional dyspepsia = a defined disorder of gut–brain interaction
Are dyspepsia and gastritis the same thing?
No.
Gastritis is a diagnosis meaning that inflammation is present in the lining of the stomach, and is mostly defined by histological assessment.
Dyspepsia describes the symptoms the patient experiences.
A patient with dyspepsia may therefore have gastritis, but does not have to. Equally, a person with gastritis may have no marked dyspeptic complaints.
Are dyspepsia and an ulcer the same thing?
No.
A stomach or duodenal ulcer can cause dyspepsia; but most patients with dyspepsia do not have an ulcer.
An ulcer is a genuine defect in the lining, visible at endoscopy.
Are dyspepsia and gastroparesis the same thing?
No.
Gastroparesis is a condition in which gastric emptying is objectively shown to be delayed in the absence of a mechanical obstruction.
Because symptoms such as early satiety, fullness after meals and nausea can resemble each other, the two are sometimes confused.
Should everyone with dyspepsia have an endoscopy?
No.
Gastroscopy is not needed in every patient with dyspepsia. The decision is made according to the patient’s age, the characteristics of the complaints, the medicines they take, their family history, risk factors and any accompanying alarm findings.
In some patients it may be preferred to look for H. pylori first, and/or to try an appropriate treatment.
If the endoscopy is normal, can it still be dyspepsia?
Yes.
In many people with dyspeptic complaints, gastroscopy shows no ulcer, tumour or other obvious structural disease that would explain them.
Where the clinical features and the diagnostic criteria fit, functional dyspepsia can be considered in these people.
Which symptoms should be assessed more carefully?
The presence of the following alongside dyspepsia may call for separate assessment:
- New or progressive difficulty swallowing
- Gastrointestinal bleeding
- Vomiting blood
- Black, tarry stools
- Unexplained iron deficiency anaemia
- Unintentional weight loss
- Persistent or repeated marked vomiting
- Family history and other important risk factors
The presence of one of these does not necessarily mean there is cancer, but it should not be brushed aside as “just indigestion”.
How is dyspepsia treated?
Treatment is directed at the cause of the dyspepsia.
Where H. pylori is found, eradication treatment can be given. Where there is an ulcer or a problem related to medication, treatment is planned for that.
In functional dyspepsia, acid-suppressing treatments, dietary adjustments and, in selected patients, treatments affecting gastric motility or gut–brain interaction can be used according to the patient’s predominant complaint.
Giving every patient with dyspepsia the same treatment is therefore not right.
Does diet matter?
Some people feel more discomfort particularly after large and fatty meals.
Eating smaller portions, not eating too quickly, and cutting down the foods that clearly increase the complaints in that person can help.
But drawing up long lists of forbidden foods, and removing a large number of foods from the diet unnecessarily, is not right.
Can dyspepsia be a sign of cancer?
The great majority of dyspepsia does not arise from cancer. Even so, cancers of the stomach and other parts of the upper gastrointestinal tract can sometimes produce dyspeptic complaints at the outset.
Assessment of the patient therefore matters particularly where complaints are newly started and there are accompanying risk or alarm findings.
Does dyspepsia turn into cancer?
There is an important distinction here:
Dyspepsia is not a disease but a group of symptoms; so there is no question of it “turning into cancer”.
What matters is identifying the cause underlying the complaints.
The difference between dyspepsia and functional dyspepsia
| Dyspepsia | Functional dyspepsia | |
|---|---|---|
| What is it? | A group of symptoms | A defined clinical disorder |
| Main symptoms | Early satiety, fullness after meals, epigastric pain/burning | The same core symptoms |
| Can there be an underlying disease? | Yes | No structural disease explaining the complaints |
| Endoscopy | Can be normal or abnormal | No explanatory structural cause on the necessary assessment |
| H. pylori | May be present | May need looking for and treating if present |
| Can there be an ulcer? | Yes, it can be the cause of the dyspepsia | If an ulcer explains the complaints, it is not called functional dyspepsia |
| Treatment | According to the cause | Individualised to the predominant symptom |
In brief
Dyspepsia = the group of upper gastrointestinal complaints made up of early satiety + fullness after meals + epigastric pain and/or burning.
Dyspepsia is not a synonym for gastritis or for an ulcer.
The patient’s complaints are assessed first; where needed, testing for H. pylori, gastroscopy or other investigations are carried out. If no explanatory structural cause is found and the appropriate criteria are met, the diagnosis of functional dyspepsia comes into question.
Note: This information is provided for general patient education. Where there are findings such as new or progressive difficulty swallowing, gastrointestinal bleeding, unexplained weight loss, iron deficiency anaemia or persistent vomiting, medical assessment should not be delayed.
Sources
- Prof. Ali Tüzün İnce, MD