Implications of dyspepsia for the NHS

There is no precise definition of dyspepsia. It can be defined pragmatically as upper abdominal or retrosternal pain, with or without other symptoms thought to be arising from the upper gastrointestinal tract—which is the approach that has been generally adopted by epidemiological studies.

Dyspepsia is not new and has been known throughout history (Indigestion by Cruickshank (1792-1872))

It has been suggested that dyspeptic symptoms can be categorised as ulcer-like, reflux-like, and dysmotility-like as a guide to the underlying cause. These groups, however, overlap considerably, with mixed patterns being common. Symptom patterns are not strong predictors of underlying disease. Recently it has been proposed that if heartburn or acid regurgitation are the dominant symptoms then these are sufficiently accurate predictors of gastro-oesophageal reflux to make a safe and accurate diagnosis (see next article). Fewer than a fifth of sufferers have this symptom pattern, and the predictive accuracy needs confirmation.