Snapshot A 26-year-old woman presents to her physician’s office for persistent epigastric pain, especially after eating meals. She also reports having significant bloating. She denies any unintentional weight loss, vomiting, or dysphagia. She is started on a proton pump inhibitor. Four weeks later, she returns for follow-up with significant improvement of symptoms. Presentation Clinical definition dyspepsia, or persistent epigastric pain, without ulcers, gastritis, or any other gastrointestinal structural or mobility abnormalities Associated conditions gastroesophageal reflux disease (GERD) irritable bowel syndrome (IBS) gastroparesis Epidemiology Demographics very common Risk factors gastroenteritis Helicobacter pylori infection smoking ETIOLOGY Pathogenesis unclear but may be related to visceral motor and sensory dysfunction and disturbances in gut microbiome Presentation Symptoms burning epigastric pain or discomfort postprandial fullness early satiety bloating belching Physical exam unremarkable IMAGING Endoscopy indicated to rule out ulcers, gastric cancer, or gastritis in certain patients patients 60 years of age or older patients < 60 years of age and > 1 alarm symptom weight loss dysphagia odynophagia blood in stool or emesis persistent nausea and vomiting anemia adenopathy palpable abdominal mass Studies Helicobacter pylori testing urea breath test fecal antigen test Differential Peptic ulcer disease distinguishing factors endoscopy will show duodenal or gastric ulcers may test positive for Helicobacter pylori DIAGNOSIS Diagnostic testing diagnostic approach typically clinically made but is often a diagnosis of exclusion Treatment First-line proton-pump inhibitors or H2 blocker Helicobacter pylori eradication therapy indications positive for H. pylori regimen proton-pump inhibitor clarithromycin amoxicillin or metronidazole Conservative avoid certain foods alcohol caffeine foods high in fat Complications Decreased quality of life