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Differential diagnosis

Functional dyspepsia, non-ulcer dyspepsia

  • More frequent among persons below 45 years of age, a diagnosis of exclusion
  • General dyspepsia without predominating symptoms of gastro-oesophageal reflux
  • Typical history is age under 40 years, discomfort in the upper part of the abdomen, bloating, symptoms of irritable bowel, myalgia, social and/or psychological problems, total length of dyspepsia less than 4 years
  • Clinical examination reveals no pathologic findings except for possible psychosocial features
  • Investigations with upper GI endoscopy, blood tests, ultrasound is negative

Peptic ulcer disease, unspecified

  • More often persons older than 45 years, with previously detected peptic ulcer or periods with dyspepsia
  • Earlier peptic ulcer but no eradication of H pylori, the patient has peptic ulcer disease
  • History with periods with dyspepsia, relief from eating, relief from antacids, night pains, smoker, localised pain centrally or in upper right corner of the epigastrium
  • No clinical findings except for possible soarness with palpation
  • The clinical diagnosis is very uncertain, the diagnosis should be confirmed with endoscopy

Gastro-oesophageal reflux disease

  • All age groups, but increasing prevalence with age
  • History with reflux symptoms like heartburn, acid regurgitations, burning pain in the epigastrium, relief from antacids, in some cases dysphagia and coughing
  • Normal clinical examination
  • The diagnosis can be made clinically, but may be confirmed with upper GI endoscopy (look for oesophagitis) or 24h pH-measurements

Side-effects of medications

  • Salicylates and NSAIDs may cause both dyspepsia and ventricular ulcer


  • Occur among young, middle-aged and elderly; three times as frequent among women as men
  • Episodes with longlasting pain of hours duration, in addition attacks of intense colicy pain lasting minutes, usually located below the right costal bow, with possible radiation to the back or to the right shoulder
  • Few or no complaints outside attacks
  • During the attack the patient is restless, tenderness with palpation and percussion below the right costal bow
  • Fever may indicate cholecystitis
  • The diagnosis is confirmed with ultrasound or ERCP

Gastric cancer

  • Often first time dyspepsia in an elderly person
  • No specific symptoms or a feeling of fullness, early satiety when eating, reduced appetite, fatigue, weight loss
  • Usually no specific findings except for possible anemia and general fatigue
  • The diagnosis is made with endoscopy and biopsy


  • Uncertain correlation with symptoms
  • Indicates primarily histologic changes usually caused by infection with Helicobacter pylori


  • Can be a manifestation of duodenal ulcer disease, especially when there are erosive changes og the patient is Hp-positive

Alcohol related dyspepsia

  • Known (concealed?) abuse of alcohol
  • Dyspepsia with discomfort, pain, nausea, vomiting, reflux symptoms
  • Clinical findings that may indicate alcohol abuse - plethoric face, palmar erythema, spider naevis, atrofic testes, gynecomasty, dilated cutaneous veins on the abdomen, peripheral muscular atrophy, jaundice
  • Upper GI endoscopy frequently demonstrate no other findings than superficial mucosal erosions in the oesophagus and stomach, with possible hemorrhagic gastritis

Heart disease

  • Exercised induced discomfort, consider angina pectoris
  • Examine for signs of heart failure
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