dyspepsia

The organic causes are peptic ulcer disease, gastro-oesophageal reflux, gastric or oesophageal malignancy, medication effects particularly NSAIDs, and less often pancreaticobiliary disease; when investigation is negative the diagnosis is functional dyspepsia, which accounts for the majority. Management is driven by age and alarm features. Alarm features — unintentional weight loss, dysphagia, odynophagia, persistent vomiting, gastrointestinal bleeding or iron deficiency anaemia, a palpable mass, and new onset over the age of sixty — mandate upper endoscopy. Without them, the standard approach is test-and-treat for Helicobacter pylori using a urea breath test or stool antigen, with proton pump inhibitors withheld for two weeks beforehand to avoid false negatives, followed by empirical acid suppression if symptoms persist. H. pylori eradication uses quadruple therapy or clarithromycin triple therapy depending on local resistance. Functional dyspepsia may respond to proton pump inhibitors, prokinetics, or low-dose tricyclics. Epigastric pain radiating to the back with weight loss should prompt consideration of pancreatic cancer.