3. The Clinical Approach to Dyspepsia

  1. John N. Plevris MD, PhD, FRCPE, FEBGH3 and
  2. Colin W. Howden MD, FRCP (Glasg.), FACP, AGAF, FACG4
  1. Mary Farid MD1 and
  2. Brennan Spiegel MD, MSHS1,2

Published Online: 29 NOV 2011

DOI: 10.1002/9781444346381.ch3

Problem-Based Approach to Gastroenterology and Hepatology

Problem-Based Approach to Gastroenterology and Hepatology

How to Cite

Farid, M. and Spiegel, B. (2012) The Clinical Approach to Dyspepsia, in Problem-Based Approach to Gastroenterology and Hepatology (eds J. N. Plevris and C. W. Howden), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346381.ch3

Editor Information

  1. 3

    Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

  2. 4

    Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Author Information

  1. 1

    UCLA Affiliated Training Program in Digestive Diseases, University of California, Los Angeles, USA

  2. 2

    VA Greater Los Angeles Healthcare System David, Geffen School of Medicine at UCLA, USA

Publication History

  1. Published Online: 29 NOV 2011
  2. Published Print: 17 JAN 2012

ISBN Information

Print ISBN: 9781405182270

Online ISBN: 9781444346381



  • dyspepsia;
  • abdominal discomfort;
  • Helicobacter pylori;
  • test and treat;
  • upper abdominal pain;
  • non-ulcer dyspepsia;
  • functional dyspepsia;
  • abdominal fullness;
  • epigastric pain;
  • proton pump inhibitor;
  • H2-receptor blockers


Dyspepsia is a common complaint encountered in clinical practice. It is defined as chronic or recurrent pain or discomfort centered in the upper abdomen. In addition, symptoms may include early satiety, bloating, upper abdominal fullness, or nausea. Patients with dyspepsia who are over the age of 55 or who have alarm signs or symptoms should undergo prompt upper endoscopy. For all other patients, two treatment strategies are proposed, including: (1) “test and treat” for Helicobacter pylori, and (2) empirical trial of anti-secretory therapy with a proton pump inhibitor. Further investigation, such as upper endoscopy, should be considered on a case-by-case basis. This chapter reviews the most current guidelines regarding the definition of dyspepsia and functional dyspepsia, the role of endoscopy as part of the initial evaluation, the role of H. pylori, and potential treatment strategies.