Dyspepsia refers to acute, chronic, or recurrent pain or discomfort centered in the upper abdomen.

Discomfort may be characterized by or associated with upper abdominal fullness, early satiety, burning, bloating, belching, nausea, retching, or vomiting. Dyspepsia often have heartburn (retrosternal burning) as symptom, but if heartburn is dominant complaint, GERD is nearly always present. Alarm symptoms : Anemia, Loss of weight, Anorexia, Recent onset of progressive symptoms, Maelena or Hematemesis, swallowing difficult Dyspepsia occurs in 25% adult population and 3% as general medical office visits. Etiology Food or Drug Intolerance Food overeating, eating too quickly, eating high-fat foods, eating during stressful situations, or drinking too much alcohol or coffee Drugs aspirin, NSAIDs, Antibiotics (metronidazole, macrolides),diabetes drugs ( metformin, alphaglucosidase inhibitor,amylin analogs,GLP-1 receptor antagonists), cholinesterase inhibitors (donepezil, rivastigmin), corticosteroids,digoxin, iron and opioids Luminal GIT Dysfunction GERD-20% dyspepsia Peptic ulcer disease-5-10% Gastric ulcer 1% Gastroparesis, lactose intolerance, malabsorbtive conditions, and parasitic infection Helicobacter Pylori Infection Prevalence of H pylori-associated chronic gastritis in patients with dyspepsia without peptic ulcer disease in 20-50% Pancreatic carcinoma and chronic pancreatitis Biliary Tract Disease Abrupt onset of epigastric or right upper quadrant pain due to choledocholithiasis Others Conditions Diabetes, Thyroid Disease, Renal insufficiency, pregnancy Functional Dyspepsia Most common cause of chronic dyspepsia. 2/3 patients have no obvious organic cause for their symptoms after evaluation. Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying or impaired accommodation to food, or psychosocial strossors Symptoms and Signs Nonspecific nature of dyspeptic symptoms, the history has limited diagnostic utility. It should be clarify the chronicity, location, and quality of discomfort, its relationship with meals, and relieved with antacids. Concomitant weight loss, persistent vomiting, constant or severe pain, dysphagia, hematemesis, or malena warrants endoscopy or abdominal imaging. Patient reason for seeking medication related to anxiety, depression and fear for serious disease. Patient with functional dyspepsia often are younger, report a veriety of abdominal and extragastrointestinal complaint, show signs of anxiety or depression, or have a history of use psychotropic medication.

Symptoms profile alone does not differentiate between functional dyspepsia and organic gastrointestinal disorders. Based on history the clinical history alone, misdiagnose nearly half of patients with peptic ulcers or GERD and have <25% accuracy in diagnosing functional dyspepsia. Physical examination are rarely helpful. Signs of serious organic disease such as weight loss, organomegaly, abdominal mass, or fecal occult blood are further evaluated. In patient >50 years, initial laboratory work should include a blood count, electrolytes, liver enzymes, calcium, and thyroid function tests.