What is behind dyspepsia?

Abstract

The first aim of the present study was to determine the cause of dyspepsia after negative conventional diagnostic work-up. In such patients, an extended diagnostic work-up was performed including esophageal pH monitoring and manometry, gastric and hepatobiliary scintigraphy, and lactose tolerance test. In 88 of 220 dyspeptic patients (mean age 49 years, range 17-87; 114 women) presenting to our gastroenterological outpatient department, a cause for dyspepsia was found by conventional work-up. Thirty-one of the remaining patients did not enter extended work-up because of minor symptoms. In 47 of 101 patients entering extended work-up, a diagnosis was established (21 endoscopy-negative gastroesophageal reflux disease, 11 gastric stasis, 6 biliary dyskinesia, and 5 lactase deficiency among them). A second aim of the study was to determine whether clusters of symptoms such as "gastroesophageal reflux-like," "dysmotility-like," and "dyspepsia of unknown origin" reliably predict the groups of diseases suggested by these terms. This was not the case. In conclusion, in 40% of dyspeptic patients, a conventional diagnostic work-up led to a diagnosis that explained a patient's symptoms. After a negative conventional diagnostic work-up, an extended diagnostic work-up with functional tests yielded a possible explanation for their symptoms in 47% of patients. In such patients symptomatology was of little help for predicting the diagnosis.

Dyspepsia in general practice in Denmark: A 1-year analysis of consulters in general practice

“…In this way it was possible to subgroup 84% into a single subgroup, which is superior to the findings reported elsewhere (11,12,19). Grainger et al (12) found that 46% of the consulters presented with a combination of dyspepsia subgroups compared to 16% in our study.…”

“…The inter-observer agreement on the decision level (dyspepsia subgrouping and presence/absence of alarm symptoms) indicated that the diagnostic chart could be obtained sufficiently comparably between doctors. We did not intend to compare our classification system with a system based on invasive investigation procedures since the discrepancy between these two systems is well documented (10,19,20). Furthermore the study was based on patients managed in general practice.…”

Prevalence of functional dyspepsia in an outpatient clinic with primary care physicians in Japan

“…It has been reported that a large majority of uninvestigated people with dyspepsia in the general population do not have organic diseases [28][29][30]. In the present study, out of 381 patients with upper abdominal symptoms, 126 (33.2%) had organic diseases that could explain their symptoms.…”

Epigastric Fullness

“…Symptoms are not reliable indicators of underlying disorders (2). In a study of 101 patients with symptoms of dyspepsia, an extended workup, including assessments of esophageal motility and transit, gastroesophageal reflux, gastric emptying, hepatobiliary function and lactose absorption, revealed abnormalities, potentially accounting for symptoms in 47 cases; no more than 11 had gastric stasis, whereas 21 had endoscopy--negative gastroesophageal reflux, six had biliary dyskinesia and five had lactase deficiency (3).…”