Updated: 5/27/2019

Non-Ulcer Dyspepsia

Review Topic
  • 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.
  • Clinical definition
    • dyspepsia, or persistent epigastric pain, without ulcers, gastritis, or any other gastrointestinal structural or mobility abnormalities
  • Epidemiology
    • demographics
      • very common
    • risk factors
      • gastroenteritis
      • Helicobacter pylori infection
      • smoking
  • Pathogenesis
    • unclear but may be related to visceral motor and sensory dysfunction and disturbances in gut microbiome
  • Associated conditions
    • gastroesophageal reflux disease (GERD)
    • irritable bowel syndrome (IBS)
    • gastroparesis
  • Symptoms
    • burning epigastric pain or discomfort
    • postprandial fullness
    • early satiety
    • bloating
    • belching
  • Physical exam
    • unremarkable
  • Diagnostic testing
    • diagnostic approach
      • typically clinically made but is often a diagnosis of exclusion
    • 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
  • Peptic ulcer disease
    • distinguishing factors
      • endoscopy will show duodenal or gastric ulcers
      • may test positive for Helicobacter pylori
  • 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
  • Decreased quality of life

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