10-minute consultation: Dyspepsia.

x Is this really dyspepsia? Ask about epigastric pain; heartburn and acid regurgitation; attitudes towards meals; lying flat; and response to antacids. Consider biliary or cardiac pain. Predominant bloating may indicate aerophagia or the irritable bowel syndrome. x Be alert to “alarm symptoms” (weight loss, anaemia, vomiting, jaundice, and epigastric mass); patients aged 55 and over with recent onset of symptoms; and continuous epigastric pain. These suggest Barrett’s oesophagus, pernicious anaemia, atrophic gastritis, or upper gastrointestinal cancer. x Ask about drug use. Non-steroidal anti-inflammatory drugs and aspirin commonly cause dyspepsia (steroids, theophyllines, and calcium antagonists are less common causes). x Has the patient been investigated previously? Peptic ulcer disease and oesophagitis can recur, but a previously normal investigation may not exclude new disease.