GI Conditions
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      Chronic Dyspepsia

      Brief Overview: According to UpToDate, “Dyspepsia refers to bothersome upper abdominal symptoms that are often meal related. The predominant symptoms are fullness (or bloating) after meals, early satiety (inability to finish a normal-sized meal because of postprandial discomfort), or epigastric pain (or burning) that may or may not be related to meals. If dyspepsia is chronic, epigastric pain is a less common feature than postprandial fullness or satiety.” Dyspepsia is considered chronic when symptoms are present for three months or longer.

      Prevalence: Dyspepsia is estimated to affect 20% of the population.

      Etiology: Many cases of chronic dyspepsia are idiopathic (functional dyspepsia). Known causes of chronic dyspepsia include peptic ulcer disease, gastroesophageal malignancy, drug-induced dyspepsia, biliary pain, and constipation. There are some other rare causes as well, like celiac disease and chronic pancreatitis.

      Risk Factors:

      • Female
      • Increased stress
      • Tobacco use
      • Certain medications, like NSAIDs
      • Certain GI diseases – peptic ulcers, gastritis, stomach cancer, etc.

      Commonly Associated Conditions:

      • GERD
      • Gastroparesis
      • IBS
      • Celiac disease

      Common Medications:

      • Treatment of any underlying condition
      • Antibiotics if H. pylori infection
      • PPI
      • H2 blockers
      • Neuromodulators – tricyclic antidepressant (like amitriptyline) or the atypical antidepressant mirtazapine
      • Prokinetic agents – metoclopramide

      Common Labs, Imaging, and Tests:

      • CMP, CBC, lipase, amylase
      • pylori testing
      • Upper endoscopy
      • Gastric emptying study may be indicated
      • Abdominal ultrasound may be indicated

      Common Symptoms:

      • Feeling of fullness or bloating after meals
      • Early satiety
      • Epigastric pain or burning
      • Nausea, vomiting
      • Belching

      Common Treatments:

      • Medications (see above)
      • Dietary modifications may be recommended
      • Complementary therapies may be recommended
      • Brain-Gut Behavioral therapy – this includes CBT, hypnosis, and relaxation therapy

      Physical Findings:

      • Typically, normal physical exam
      • Epigastric tenderness may be present

      Potential Complications and Contraindications:

      • Impaired quality of life
      • Overuse of PPIs
      • Caution with certain medications in older adults or cardiac risk patients

      General Health and Lifestyle Guidance:

      • Smoking cessation
      • Keep a food/symptom diary to help determine any dietary triggers. Show this to your healthcare provider for evaluation.
      • Ask your healthcare provider if you need to avoid any medications (like NSAIDs)
      • Ask your healthcare provider if peppermint or caraway oil may be helpful for you. Do not take any OTC supplements or vitamins before talking to your healthcare provider first.

      Suggested Questions to Ask Patients:

      • When do your symptoms occur—before, during, or after eating?
      • Do certain foods make your symptoms worse?
      • Have you noticed any weight loss, vomiting, or blood in stool?
      • Have you been tested for H. pylori or had an upper endoscopy?

       

      Suggested Talking Points:

      • Consider acupuncture as adjunctive therapy. Ask your healthcare provider about this first.
      • Consider working with a dietician to determine which dietary modifications are most likely to improve symptoms
      • Make sure to report any new, worsening, or persistent symptoms to your healthcare provider

      Sources:

      • UpToDate
      • NIDDK
      • AAFP