Non-Ulcer Dyspepsia

Abstract

Dyspepsia is a term which covers a multitude of symptoms and has no commonly agreed definition. It is often used interchangeably with indigestion, but has a pseudo scientific ring to it which may be useful in reassuring the patient that his condition is taken seriously, but may unfortunately delude the doctor into believing he has a greater understanding of the patient’s condition than is actually the case. A survey¹ conducted recently amongst groups of senior hospital doctors and patients with a variety of gastroenterological and nongastroenterological disorders showed that there was much confusion as to what dyspepsia and indigestion implied. It seems that doctors by and large consider both terms to describe those symptoms typically associated with peptic ulceration. Most patients, on the other hand, though sometimes using the term dyspepsia, are uncertain what it means and are more conversant with indigestion. Unlike their medical counterparts, they are not familiar with the classical symptoms of peptic ulcer and give a less fettered account of what indigestion entails. Many of the symptoms which patients in that survey listed as indigestion, whether they were perennial or only occasional sufferers, more closely resembled irritable bowel syndrome than peptic ulceration. In this study¹ we were careful not to bias our findings in favour of the hypothesis that indigestion may equate with a functional bowel disorder by excluding patients with such a diagnosis. The study revealed that 80% of those questioned suffered occasional indigestion. Only half of the patients understood what dyspepsia meant, but most of the doctors considered that indigestion and dyspepsia were synonymous. Not surprisingly, around four-fifths of the patients and doctors included upper abdominal pain, wind, heartburn and acid regurgitation as typical indigestion/dyspepsia symptoms. More surprisingly, over half of the patients listed lower abdominal pain and irregular bowel habit, especially constipation, as characteristic features of indigestion and just less than half also included headache and backache. The majority considered that predominant causes were heavy meals, over spiced food, alcohol and worry. A similar proportion felt that relief was best achieved by taking antacids or laxatives, particularly if the preparation induced belching. Interestingly the patients, unlike the doctors, did not accept that drinking milk was likely to give relief.