22/05/2026
Dyspepsia is a common condition that causes pain or discomfort in the upper abdomen (epigastric area) for at least 1 month. It is usually related to stomach problems.
Heartburn (pyrosis) refers to burning chest discomfort caused mainly by esophageal problems. Although dyspepsia and heartburn are different conditions, their symptoms can overlap.
Common causes of dyspepsia include:
* Helicobacter pylori (H. pylori) infection
* Gastritis
* Esophagitis
* Gastroesophageal reflux disease (GERD)
* Peptic ulcer disease (PUD)
Evaluation should include:
* Detailed medical history
* Physical examination
* Assessment of risk factors
* Checking for “red flag” symptoms such as weight loss, bleeding, anemia, vomiting, or difficulty swallowing
Management:
* Patients aged ≥ 60 years should undergo upper endoscopy (EGD) to rule out cancer before starting treatment.
* All patients with typical dyspepsia should be tested for H. pylori and treated if positive.
* Patients < 60 years without major red flag symptoms may start empirical acid suppression therapy, usually with proton pump inhibitors (PPIs).
* If symptoms do not improve, further investigations are needed.
Patients with unusual symptoms should also be evaluated for other causes such as:
* Gallstones (cholelithiasis)
* Chronic pancreatitis
* Stable angina
If no structural or organic cause is found, the patient may have functional dyspepsia, which accounts for about 70% of dyspepsia cases. Diagnosis is based on the Rome IV criteria.
