Dyspeptic symptoms in the community.
Authors: R Jones
Journal: Gut (1989)

Dyspeptic symptoms in the community An international working party recently proposed a definition of dyspepsia as 'upper abdominal or retrosternal pain, discomfort, heartburn, nausea, vomiting, or other symptom considered to be referable to the proximal alimentary tract.'This broad definition was divided into non-ulcer dyspepsia, with symptoms lasting for more than four weeks, unrelated to exercise and for which no focal lesion or systemic disease can be found responsible, and organic dyspepsia, caused by specific lesions such as peptic ulcer, reflux oesophagitis, gastric carcinoma and cholelithiasis, which could be readily identified on routine investigation.This definition is similar to that proposed in a position paper published by the Health and Public Policy Committee of the American College of Physicians, in which the basic element of dyspepsia was said to be epigastric pain or discomfort, accompanied by fullness, burning, belching, bloating, nausea, vomiting, fatty food intolerance or difficulty completing a meal.2The authors of this paper were confident that heartburn, defined as a hot or burning sensation located in the substernal region and often related to position, is generally distinguishable from dyspepsia.In reality this distinction may not be so easy to make, because a recent community survey of dyspeptic symptoms has shown that both upper abdominal discomfort and heartburn are frequently experienced by people with upper alimentary digestive complaints.3It is clear that dyspeptic symptoms are commonly seen in the general population, however broad and imprecise the definition; they are a frequent cause of consultation with general practitioners and also account for a substantial proportion of patients referred to gastroenterology clinics.Although recent years have seen the documentation of significant changes in the epidemiology and natural history of peptic ulcer disease,' little corresponding data on dyspepsia have been published for over 20 years.Doll, Avery-Jones, and Buckatztch published a large study in 1951 in which they described the prevalence of dyspepsia and peptic ulcer disease and sought to link this to occupational factors.9They investigated over 6000 employees working for a variety of companies in London, asking whether they had ever had a peptic ulcer or suffered from indigestion; on the basis of an interview the subjects were classified, rather arbitrarily, into 'major' and 'minor' dyspepsia or no dyspepsia.They found that 17% of patients had minor dyspepsia and 13% major dyspepsia; those with major dyspepsia were interviewed and 334 peptic ulcers were diagnosed (of which 69% were presumptive diagnoses based on the clinical history).The general con- clusions of the study were that almost 30% of the sample had suffered dyspepsia in the preceding five years and almost 2% had peptic ulceration.Duodenal ulcers appeared to be more common in men between the ages of 20 and 64 years, with the highest incidence in those holding 'responsible positions'.It also appeared that anxiety over work and personality factors leading to anxiety were unduly common in subjects with ulcers.Gastric