What causes Dypepsia?

A great many people in the western world suffer from dyspepsia.  They usually complain of the discomfort or pain in the upper abdomen that they get chronically - this means that they suffer from it regularly and often.  Sufferers often learn to eat small meals, drink antacids or milk or take to sucking mints which can cause some relief. 

In the majority of people, the symptoms of dyspepsia is caused by their diet or smoking.  There are several things in the diet can cause dyspepsia including spicy food, alcohol, a lot of bulky food or foods with high fat contents.  Smoking stimulates acid production in the stomach and so also increases the risk of dyspepsia. 

There has been a lot of interest over the last decade or so about a bacteria called Helicobacter pylori (H. pylori) that can live in the acid in the stomach.  Although the stomach acid usually kills or bacteria, H.  Pylori produces an ammonia which neutralises the acid and allows it to live quite comfortably here. 

A few patients get dyspepsia from drugs that they are on. The commonest drugs that cause dyspepsia the nonsteroidal anti-inflammatorys (NSAIDs - such as aspirin, indomethacin, Voltarol etc).  If this is the case, the Dyspepsia starts after the drug is been started and is often improved when the drug is stopped. 

Uncommonly, but very importantly, peptic ulceration (a stomach ulcer or duodenal ulcer) or stomach cancer can cause dyspepsia.

Is dyspepsia serious?

In most patients with dyspepsia, there is no serious cause.  However in a very few, it can be.  Therefore iIf dyspepsia will come as a regular symptom, it will be worth seeing a family doctor in the first instance. 

A family doctor will decide whether the Dyspepsia is serious enough to investigate further or not. 

Who needs investigations for dyspepsia? 

Generally, younger people (under 55 years of age) who have mild dyspepsia only with no other symptoms should be examined to make sure there are no lumps, nodes or abnormalities in their abdomen, neck or groins.  In such people, treatment can be started although many had revised for a simple test for H.  Pylori.  This can be done by a simple breath test where it tablets and swallowed and an indicator strip held in front of the mouth which will indicate if the tablet has been broken down by H. pylori. 

Of course if there are any worrying symptoms, such as unexplained weight loss or change of bowel habit, or if any lumps or bumps are felt examination, then further investigations will be performed as below. In people over the age of 55 years, and those younger but with worrying symptoms as above, investigations should be performed.  Nowadays, the most common investigation for this is gastroscopy. 

Gastroscopy - OGD or oesophagogastroduodenoscopy 

Usually called OGD (Oesophago-Gastro-Duodenoscopy after the structure it passes through) it is a flexible tube that is passed through the mouth, down through the oesophagus and in to the stomach and finally the duodenum.  The gastroscope has fibre-optic inside it that takes light down into the structures and allows the operator to see the walls in great detail.  There is also a very fine tube that allows instruments to be passed down so that samples can be taken if anything nasty or suspect is seen. 

Gastroscopy, or OGD, is mildly uncomfortable but performed under sedation, is a quick and highly effective investigation.  Through this, an expert operator will be to identify if there are any changes due to medication (called erosions), any stomach or duodenal ulcers, any cancers or any other abnormalities that might be there.