CLINICAL REVIEW Investigating dyspepsia

Dyspepsia is a complex condition comprising chronic and recurrent symptoms related to the upper gastrointestinal tract. The cardinal symptoms are epigastric pain and discomfort, including postprandial fullness and early satiety, which may overlap with heartburn and regurgitation. Box 1 shows the various definitions of dyspepsia. Around 25-40% of adults in the general population have dyspepsia, 2 and dyspepsia accounts for 2-5%of all consultations in primary care.Although several guidelines have been published, 2 4-7 the management of patients with uninvestigated dyspepsia is still controversial. One outstanding dilemma is the choice of the most appropriate empirical strategy; the benefit of early endoscopy in older patients without alarmsymptoms is alsowidelydebated.Dyspepsiahas a substantial economic impact, and appropriate management is essential to reduce costs. This review examines strategies for managing patients with uninvestigated dyspepsia in primary care. We provide an overview of current guidelines and recommendations and report recent evidence from systematic reviews and clinical trials.