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  • This document is a translation of a document from www.legehandboka.no (suited for healthcare professionals)

Key facts

Definition

  • Continuous or relapsing pain or discomfort localised in the upper part of the abdomen1-2
  • The pain and discomfort can be accompanied by fullness, a feeling of early satiety, meteorism, nausea, vomiting, acid regurgitation and heartburn
  • If acid regurgitations and heartburn are the dominating symptom, the condition is classified as gastro-oesophageal reflux disease3
  • Uninvestigated dyspepsi is a term used on patients with dyspepsia who have never had an upper GI endoscopy

Incidence/prevalence

  • Prevalence
    • In periods dyspepsia occurs in 20-40% of the population
    • Life time prevalence is found to be 20-50%4
    • Dyspepsia is reason for encounter in 2% of all consultations in general practice5
  • Among patients undergoing upper GI endoscopy for dyspepsi6, it is found that
    • 15-20% have peptic ulcer
    • 10-15% have oesophagitis
    • 1% have gastric cancer
    • 50-70% will have no endoscopic explanation for the symptoms
  • Community medicine
    • Dyspepsia is associated with large expenditures caused by sick leave, physician encounters, investigations and medications7-8

Diagnostic clues

  • The diagnostic challenge is to identify the patients with peptic ulcer disease, because
    • it is a potential serious disease
    • peptic ulcer disease may now be cured by eradicating the Helicobacter pylori-infection
  • Heterogenous complex of symptoms
    • Dyspepsia is a symptomatic condition that includes diseases with overlapping symptoms, wherein the medical history has a limited diagnostic value9-11 - in addition the symptoms may vary over time12
    • Functional dyspepsia occurs about 5 times as frequent as peptic ulcer disease
    • In general practice the positive predictive value of the clinical diagnosis of peptic ulcer is found to be appr. 25%6
    • Symptoms, signs and clinical findings can not be used to differentiate between a duodenal and ventricular ulcer
  • NSAIDs and gastric ulcer
    • The probability for gastric ulcer is increased among elderly people and among users of NSAIDs and salicylates13
    • The risk of getting a gastric ulcer is increased 5-7 fold in the first three months with regular intake of NSAIDs, later it is 4 foldly incrased and two months after cessation the risk level is back to normal
    • There is a clear dose-response relation
  • Alarm symptoms
    • May indicate malignant disease or a complicated ulcer disease and warrant immediate referral for more extensive diagnostic work-up
    • Difficulty swallowing, gastrointestinal bleeding, acute abdominal pain, jaundice, a palpable tumor, early satiety, inexplicable weight loss, continuous vomiting, increased frequency of gastrointestinal malignancy in the family, previous peptic ulcer, lymphadenopathy
    • A meta-analysis showed, however, that the predictive value of alarm symptoms is highly uncertain (Ia)14

Reasons for encounter

  • Only 1 out of 3 patients with dyspepsia seeks medical advice
  • Concern about a potential serious disease are among the main reasons for encounter15

Diagnostic pitfalls

ICPC

  • D02 Stomachache/pain in the abdomen, unspecified
  • D03 Heartburn/acid regurgitations
  • D07 Dyspepsia/digestive disorder
  • D08 Flatulence/gas-pain/bloating/belching
  • D09 Nausea
  • D10 Vomiting
  • D87 Gastritis/duodenitis/non-ulcer dyspepsia

ICD-10

  • R10 Pain in the stomach and pelvis
  • R11 Nausea and vomiting
  • R12 Heartburn
  • R13 Dysphagia
  • R14 Flatulence and related disorders