Dyspepsia

Dyspepsia is not a condition, but rather a set of symptoms of which upper abdominal pain or discomfort is the predominant complaint. In cross-sectional surveys, the prevalence of dyspepsia (3,14,23-26) has ranged from 3% to 44%. Why this large variation? The first consideration is whether the study included the symptom of heartburn in the definition of dyspepsia. Heartburn is experienced by 20% of the population weekly and 40% annually (27). There is significant overlap between upper abdominal symptoms and heartburn (23,27), and clinical studies have shown that many people with dyspepsia have reflux even in the absence of heartburn (28). If heartburn is ignored, the surveys suggest that 15% to 20% of the population experience dyspepsia over the course of a year. The second issue is whether patients who have symptoms of IBS in addition to their symptoms of dyspepsia are included. Approximately 30% of people with dyspepsia will also report IBS symptoms (3). Exclusion of people with IBS will decrease the prevalence estimate of dyspepsia down to 10% or even 3% (25).

The prevalence of dyspepsia is similar for men and women (3,23-26). Many studies have demonstrated that the prevalence actually decreases with age (14,23,25,26). In one study, Caucasians were found to have a lower prevalence of dyspepsia than non-Caucasians (25).

The previous section summarized the proportion of people who have symptoms of dyspepsia. However, these studies have not subjected these people to a diagnostic evaluation in order to determine whether or not they had functional dyspepsia. Many of these authors have, in fact, assumed that the majority of these people have functional dyspepsia. When determining the prevalence of functional dyspepsia, the investigators often exclude people who report a history of peptic ulcer disease, and approximately 8% of the population will report such a history (3,23). However, most people have not had any investigations and some people may report a history of peptic ulcer without having had any testing. Obviously, the absence of evaluation makes it very difficult to get a true estimate of the prevalence of functional dyspepsia. Still, the few studies that have evaluated people with dyspepsia in the community have not identified significant disease (24,29,30).

As compared to the number of cross-sectional studies done to estimate the prevalence of dyspepsia and functional dyspepsia, far fewer studies provide incidence data. Like IBS, these studies have surveyed a cross section of the community on two or more occasions, one to five years apart (4,16,26,31). Approximately 10% of the population will report the onset of dyspepsia over the course of one year. Talley et al. calculated the annual incidence of dyspepsia and found it to be 56 per 1000 person-years (4). This figure is hard to interpret by itself. However, this rate of 5600 per 100,000 person-years is over 500 times larger than the current annual incidence of gastric cancer (10 per 100,000 person-years) (11).

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