COMPASS Therapeutic Notes on the Medical Management of Uninvestigated Dyspepsia in Primary Care

What is dyspepsia? Dyspepsia is not a diagnosis, but rather describes a number of symptoms that are thought to originate in the upper gastrointestinal tract. Dyspepsia is an extremely common disorder in otherwise healthy individuals. Less than half of those with symptoms seek medical care. There is no single, accepted definition for dyspepsia. In this review a broad definition of dyspepsia is used, one which is relevant and generalisable to primary care. This definition includes the presence of upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting. The inconsistency in the use of the term dyspepsia by healthcare professionals accounts for the lack of comparability between published studies of dyspepsia. This has been a major barrier to resolving clinical uncertainty about best practice for investigation and treatment of patients. Any patient presenting with symptoms of dyspepsia who has not been investigated by endoscopy is now classed as having uninvestigated dyspepsia. Where investigation occurs, differentiation is possible leading to diagnoses including: ● Peptic Ulcer Disease (PUD), or ● Non-Ulcer Dyspepsia (NUD), or ● Gastro-Oesophageal Reflux Disease (GORD). GORD can be further subdivided into oesophagitis or Endoscopically Negative Reflux Disease (ENRD).