Initial management of dyspepsia in primary care: an evidence-based approach

Abstract

The word dyspepsia derives its origin from the Greek work dyspeptos , which means ‘bad digestion’. The term is used to describe symptoms thought to be referable to the upper gastrointestinal (GI) tract. Which symptoms to include in the definition of dyspepsia is controversial, but upper abdominal pain or discomfort, bloating, fullness, early satiety, heartburn, and regurgitation may be considered part of the symptom complex. Potential aetiologies range from the benign (such as functional dyspepsia, where there is no structural cause found to explain the symptoms) to the life-threatening (gastro-oesophageal cancer). Other common underlying organic causes of dyspepsia include peptic ulcer disease and gastro-oesophageal reflux disease. Dyspepsia represents a considerable burden to the health service, and therefore optimal management of the condition in primary care is essential. This article aims to provide the reader with an update on evidence that supports current guidelines for the initial management of dyspepsia in primary care. Dyspepsia is extremely common in the community, with a prevalence in excess of 30%.1 Up to 40% of sufferers will consult a primary care physician as a result.2 The condition is often chronic, with a relapsing and remitting natural history. In a community-based longitudinal follow-up study almost 20% of people without dyspepsia at baseline had developed dyspepsia by 10 years, giving an incidence of dyspepsia of around 2% per year, while among those with symptoms at baseline, 40% had persistent symptoms at 10 years, meaning that dyspepsia resolved at a rate of approximately 6% per year.3 Reassuringly, and despite …