DYSPEPSIA

DEFINITION

Dyspepsia is defined as pain or discomfort felt to arise in the upper gastrointestinal tract with symptoms on greater than 25% of the days over the past four weeks [1]

DIAGNOSTIC CRITERIA

An international committee of clinical investigators (Rome III Committee) defined dyspepsia as one or more of the following symptoms [2]:
• Postprandial fullness (termed postprandial distress syndrome)
• Early satiation (meaning inability to finish a normal sized meal or postprandial fullness)
• Epigastric pain or burning (termed epigastric pain syndrome)

These criteria were preferred to the previous criteria (Rome II), which included pain or discomfort centered in the upper abdomen.

EPIDEMIOLOGY
It occurs in approximately 25 percent (range 13 to 40 percent) of the population each year, but most affected people do not seek medical care [3,4]. Dyspepsia is responsible for substantial health care costs and considerable time lost from work [5]. General practitioners see only a fraction of the dyspepsia within the community, the majority of which is either ignored or treated by self-medication. However, dyspepsia still accounts for about 3-4% of all general practice consultations and for about 14% of all patients attending. In about half of all cases, even extensive investigation reveals no underlying organic lesion

TYPES:
There are 4 major types of dyspepsia according to causes [7]:
• Chronic peptic ulcer disease,
• Gastroesophageal reflux (with or without esophagitis),
• Malignancy
• Functional (or nonulcer) dyspepsia.
Rome III Diagnostic Criteria for Functional Dyspepsia are [8]

1. At least 3 months, with onset at least 6 months previously, of 1 or more of the following:
• Bothersome postprandial fullness
• Early satiation
• Epigastric pain
• Epigastric burning

And
2. No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms

Rome III Diagnostic Criteria for Epigastric Pain Syndrome are [8]:
At least 3 months, with onset at least 6 months previously, with ALL of the following:

Pain and burning that is:
• intermittent
• localized to the epigastrium of at least moderate severity, at least once per week,
• and NOT:
1. generalized or localized to other abdominal or chest regions
2. relieved by defecation or flatulence
3. fulfilling criteria for gallbladder or sphincter of Oddi disorders

Rome group also suggested that it might be useful to subcategorize nonulcer dyspepsia into ulcer-like, reflux-like, dysmotility-like, and nonspecific dyspepsia [7]