Latin for "bad digestion", dyspepsia can be quite severe and even debilitating for some. Dyspepsia has been defined as "pain or discomfort centred in the upper abdomen" but people with dyspepsia may have more than one symptom.

People whose predominant symptom is heartburn (i.e. reflux or acid regurgitation, often described as a "sensation of burning in the upper chest") are usually considered to have gastroesophageal reflux disease (GERD). However, 'reflux' symptoms can also occur along with symptoms caused by peptic ulcer disease, abnormal motility (contractions of the esophagus, stomach or intestines that move food through the digestive tract) or 'non-ulcer dyspepsia'.

Because of this, the Canadian Dyspepsia (CanDys) Working Group has recently published a new, more comprehensive definition which describes dyspepsia as "a symptom complex of epigastric (upper abdominal) pain or discomfort thought to originate in the upper gastrointestinal tract, and it may include any of the following symptoms: heartburn, acid regurgitation, excessive burping/belching, increased abdominal bloating, nausea, a feeling of abnormal or slow digestion, or early satiety."

For dyspepsia to be considered a chronic condition, symptoms must be present at least 25% of the time over a period of at least three months. Dyspepsia is thought of as a group of symptoms rather than a disorder or disease, and it often occurs without any organic disease.

Dyspepsia is very common and is estimated to affect roughly ¼ of the population in Western Europe and North America. In Canada, a recent study showed 29% of the population has substantial symptoms of dyspepsia. Dyspepsia is more common in developing nations since Helicobacter pylori (H. pylori) infection, which can result in ulcers and symptoms of dyspepsia, is more prevalent.

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What are the symptoms of dyspepsia?

Because dyspepsia is a group of symptoms, rather than a disease, dyspepsia tends to vary from person to person and may be characterized by the following symptoms:

- Pain or discomfort centred in the upper abdomen
- Bloating
- Pain or burning radiating from the chest up through the throat (heartburn)
- Nausea
- Vomiting
- Excessive gas or belching
- Feeling full too soon when eating (early satiety)

Symptoms of dyspepsia can be a sign of a more serious condition. Notify your doctor if you experience;

- weight loss of more than 10 pounds (3 kilograms), or appetite loss.
- Black tarry stools or blood in vomit.
- Severe pain in the upper right abdomen.
- Discomfort unrelated to eating.
- Indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm.

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What causes dyspepsia?

Structural causes
When there is a structural cause, that is a condition like peptic ulcer disease or biliary tract disease (gallstones) is present, symptoms of dyspepsia can ensue.

Peptic ulcer disease, and poor motility (the wave-like action that moves food through the digestive tract) are other disorders which can result in symptoms associated with dyspepsia.

Functional (non-ulcer) dyspepsia
The symptoms of functional dyspepsia, also called non-ulcer dyspepsia can be quite severe, and chronic. Unlike peptic ulcer disease where ulcers are usually found in the stomach or duodenum, examination reveals no signs of any organic abnormality in functional dyspepsia. Functional dyspepsia may result from poor nerve and muscle function. Symptoms such as gas, and abdominal pain, come back again and again, but there are no signs of disease or damage. Emotional stress may trigger or worsen symptoms.

Because the symptoms of functional dyspepsia (without signs of organic disease upon examination) resemble those other organic diseases, such as peptic ulcer disease or gastroparesis (the inability of the stomach to empty properly), functional dyspepsia has been subdivided into ulcer-like, dysmotility-like or unspecified dyspepsia.

Those who experience ulcer-like functional dyspepsia tends to have symptoms similar to those who have peptic ulcer disease- heartburn and abdominal pain.

Those who experience dysmotility-like functional dyspepsia tend to experience symptoms similar to those who have gastroparesis- abdominal pain, bloating, excessive gas, nausea and vomiting.

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How is dyspepsia diagnosed?

Because the symptoms of dyspepsia may be the result of serious conditions like ulcers, gallstones, or other problems like improper stomach emptying or aerophagia (excessive swallowing or air), these causes must be ruled out as the source of the problem. Different tests are used to test for the various causes of dyspepsia.

X-ray tests
A barium meal and upper G.I. series are both X-ray examinations and involve drinking barium, a contrast solution which allows the esophagus, stomach and intestines to show up against your other internal organs.

Endoscopy
Endoscopy involves swallowing a thin flexible tube with a video camera on the end. In upper endoscopy, your doctor can visualize the duodenum, the stomach and the esophagus and can take small biopsy (tissue) samples to diagnose disease that may only be detected under a microscope.

Gastric emptying study
A gastric emptying test can be used to determine how well or slowly the stomach can empty its contents.

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What is the treatment for dyspepsia?

Again, the treatment will depend on what is causing the symptoms. If an H. pylori infection is the cause, your doctor will prescribe a combination antibiotic and acid-reducing medication to clear the infection. If gallstones are resulting in symptoms of dyspepsia, there are surgical and non-surgical treatments available.

The symptoms associated with functional dyspepsia may be alleviated by certain lifestyle changes.

The following are a list of the foods, activities and medications that may aggravate symptoms. Check with your doctor to find out which changes would most likely benefit you.

Ways to improve symptoms of dysmotility (poor stomach emptying) include: eating smaller, well-balanced meals and more frequent meals, not lying down for 2-3 hours after a meal, avoiding foods which aggravate symptoms, being a healthy weight, avoid constrictive clothing, elevating the head of your bed, stop smoking.