Evaluation of dyspepsia

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最后审阅： 27 Jan 2026

最后更新： 25 Feb 2026

Dyspepsia is a symptom or a combination of symptoms that alerts a clinician to the presence of an upper gastrointestinal (UGI) problem. Typical symptoms include epigastric pain or burning, early satiety and postprandial fullness, belching, bloating, nausea, or discomfort in the upper abdomen. Symptoms are the central focus of this assessment; it is therefore essential that they are described in a manner that is relevant to patients.[1]

Clinicians using symptom-based assessment of UGI symptoms need to be aware of the diagnostic uncertainty inherent in this approach. These assessments can provide functional working diagnoses, but there is always a danger of misclassification. An important consequence of the inability to make a definitive diagnosis based on symptoms alone is an over-diagnosis of GERD and the under-recognition of Helicobacter pylori-related disease. Periodic reassessment can add a layer of safety, but the timing and frequency of reassessment needs to be individualized.[2]

The nomenclature for dyspepsia is confusing. Some medical organizations include all UGI symptoms in the term dyspepsia, then separate patients with symptoms suggesting GERD for appropriate management. Others recognize the overlap in symptoms between the various causes of UGI symptoms but choose to separate the symptoms suggesting GERD before applying the term dyspepsia. Both approaches recommend identifying patients whose symptoms suggest GERD and managing them as having reflux disease.

The American College of Gastroenterology and the Canadian Association of Gastroenterology have published joint guidelines for the management of dyspepsia.[3] The operational definition for dyspepsia used in the guideline is predominant epigastric pain. The authors recognize that patients may present with nausea, vomiting, or fullness but, providing that the patient’s primary concern is epigastric pain, they should be managed as patients with dyspepsia.

A technical review from the American Gastroenterological Association for the evaluation of dyspepsia excludes patients with symptoms that suggest GERD, and includes only those with the typical symptoms.[4] The American College of Gastroenterology have published separate guidance on the diagnosis and management of GERD, which excludes the management of functional heartburn and other functional upper gastrointestinal symptoms.[5] The UK National Institute for Health and Care Excellence guideline on GERD and dyspepsia in adults suggests a discrete algorithm for patients with symptoms typical of GERD.[6]

Classification of dyspepsia

Patients with dyspepsia can be classified based on the type or outcomes of the investigations they have received. Research papers often refer to different categories of patients with dyspepsia; it is important to understand the descriptions of the most common subgroups that have been described.

Uninvestigated dyspepsia is classified as a condition with characteristic symptoms clinically assessed to be originating in the upper gastrointestinal (UGI) tract, but which has not been recently investigated by UGI endoscopy.[3][4][6] Symptoms include epigastric pain or burning, early satiety and postprandial fullness, belching, bloating, nausea, or discomfort in the upper abdomen.

Functional dyspepsia (FD) (sometimes called nonulcer dyspepsia) refers to a situation where investigations have not revealed a potential cause for the dyspepsia.[7] The term is generally reserved for patients with a normal endoscopy whose symptoms do not suggest GERD. The ROME IV criteria require one or more of the following symptoms, without evidence of structural disease (including at upper GI endoscopy) that is likely to explain the symptoms, for a diagnosis of FD to be made: Rome Foundation: Rome IV criteria Opens in new window

Bothersome postprandial fullness
Bothersome early satiation
Bothersome epigastric pain
Bothersome epigastric burning

The Rome IV classification subdivides FD into 3 categories:[8]

Postprandial distress syndrome (PDS), which is characterized by meal-induced dyspeptic symptoms, such as discomfort, pain, nausea, and fullness
Epigastric pain syndrome (EPS), which refers to epigastric pain, or epigastric burning, that does not occur exclusively postprandially, can occur during fasting, and can even be improved by meal ingestion
Overlapping PDS and EPS, which is characterized by meal-induced dyspeptic symptoms and epigastric pain or burning.

Patients with GERD with normal endoscopy are said to have nonerosive reflux disease.[3][4][5][9] The American College of Gastroenterology recommends that a diagnosis of nonerosive reflux disease should only be made if endoscopy is performed with the patient off proton pump inhibitors.[5]

GERD and dyspepsia are related and may overlap. There is no gold standard for the diagnosis of GERD. The diagnosis is based on a combination of symptom presentation, endoscopic evaluation of esophageal mucosa, reflux monitoring, and response to therapeutic intervention.[5] It is known that many patients with GERD will have atypical presentations such as epigastric burning or pain, and therefore their symptoms will cause them to be placed into the group of uninvestigated patients with dyspepsia. Among those undergoing endoscopy for typical GERD symptoms, normal mucosa is the most common finding.[5]

The extent or severity of the patient's dyspepsia is measured by the patient's report of the impact of symptoms on quality of life and function. The patient's assessment of the severity of dyspepsia usually relates to the degree to which it affects work, sleep, diet, or leisure.[4][6]

Epidemiology

One meta-analysis that included 256,915 patients from 40 countries found that the overall global pooled prevalence of FD was 8.4% (95% CI 7.4 to 9.5), with the highest prevalence when the Rome 1 criteria was used for diagnosis (11.9%; 95% CI 5.1 to 25.4) and lowest with Rome IV criteria (6.8%; 95% CI 5.8 to 7.9).[10] The same meta-analysis found that developing countries had higher prevalence rates when compared to developed countries (9.1% vs. 8.0%), and prevalence was higher in women (9.0% vs. 7.0%).[10]

The prevalence of FD varies by country, suggesting that economic status, geographical region, ethnicity, dietary and/or genetic influences may play a role.[10][11] The global prevalence has been gradually declining.[10]

An internet-based cross-sectional health survey found that Rome IV FD is significantly more prevalent in the US (232 [12%] of 1949 responses) than in Canada (167 [8%] of 1988 responses) and the UK (152 [8%] of 1994 responses; p<0·0001).[12] The subtype distribution was 61% postprandial distress syndrome, 18% epigastric pain syndrome, and 21% overlapping variant with both syndromes; this pattern was similar across countries.

There is evidence of particular concerns relating to FD in women.[13] Dyspepsia has been shown to have a significant negative impact on quality of life. The impact relates to changes in sleep, diet, and interference with work and leisure activities. Women who have experienced emotional or physical abuse appear to be particularly vulnerable to developing FD and irritable bowel syndrome (IBS).

There is much overlap between FD and IBS. Patients who have both disorders have a substantially greater symptom burden and are more likely to consult a physician.[14]

Differentials

Common

Functional dyspepsia (FD)
Helicobacter pylori infection
GERD and esophagitis
Peptic ulcer disease
Gastroparesis
Gastritis and duodenitis with and without erosions
Lactose intolerance
Cholelithiasis
Cholecystitis
Drug-induced dyspepsia
Celiac disease

Full details

Uncommon

Upper gastrointestinal malignancy
Intestinal parasites: Giardia, Cryptosporidium
Coronary artery disease
Chronic pancreatitis
Acute pancreatitis
Pancreatic tumors/cancers
Obstruction of the hepatobiliary tract from stricture or tumor
Hypercalcemia
Abdominal wall pain
Ovarian cancer

Full details

Contributors

Authors

Nimish Vakil, MD, FACP, AGAF, FASGE, FACG

Clinical Adjunct Professor

School of Medicine and Public Health

University of Wisconsin

Madison

Disclosures

NV is a consultant for Isothrive.

Acknowledgements

Dr Nimish Vakil would like to gratefully acknowledge Dr Nigel W. Flook, a previous contributor to this topic.

Disclosures

NWF declares that he has no conflicting interests.

Peer reviewers

Lars Aabakken, MD

Professor of Medicine

Chief of GI Endoscopy

Rikshospitalet University Hospital

Oslo

Norway

Disclosures

LA declares that he has no competing interests.

Paul Moayyedi, BSc, MB ChB, PhD, MPH, FRCP (London), FRCPC, FACG, AGAF

Director

Division of Gastroenterology

Professor

Department of Medicine

McMaster University Medical Centre

Hamilton

Ontario

Canada

Disclosures

PM is an author of a number of references cited in this topic.

Kashyap V. Panganamamula, MD, MBA, FASGE

Clinical Professor of Medicine

University of Pennsylvania School of Medicine

Director of Endoscopy, Penn Presbyterian Medical Center

Disclosures

KYP declares that he has no conflicting interests.

Catiele Antunes, MD

Assistant Professor

Section of Digestive Diseases

Yale University

New Haven

Disclosures

CA declares that she has no conflicting interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.Full text Abstract

Talley NJ, Vakil NB, Moayyedi P. AGA technical review: evaluation of dyspepsia. Gastroenterology. 2005 Nov;129(5):1756-80.Full text Abstract

Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56.Full text Abstract

National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Oct 2019 [internet publication].Full text

American College of Radiology. ACR Appropriateness Criteria®: epigastric pain. Nov 2021 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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Evaluation of dyspepsia

小结

Classification of dyspepsia

Epidemiology

Differentials

Common

Uncommon

Contributors

Authors

Nimish Vakil, MD, FACP, AGAF, FASGE, FACG

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Lars Aabakken, MD

Disclosures

Paul Moayyedi, BSc, MB ChB, PhD, MPH, FRCP (London), FRCPC, FACG, AGAF

Disclosures

Kashyap V. Panganamamula, MD, MBA, FASGE

Disclosures

Catiele Antunes, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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