Red Flag Symptoms: Dyspepsia

Dyspepsia also known as indigestion, is a condition of impaired digestion.

  • Weight loss
  • Iron-deficiency anaemia
  • GI bleeding
  • Persistent vomiting
  • Difficulty swallowing
  • Epigastric mass

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The symptoms above, particularly if the patient is over 55 years of age, should alert you to possible Barrett's oesophagus, pernicious anaemia, atrophic gastritis, or upper GI cancer.

It is important to establish how long the patient has been experiencing these symptoms and whether there is continuous epigastric pain or if the symptoms are intermittent.

Remember to enquire if there is a family history of GI cancer because this could affect your decision to refer.

Initial intervention for patients with dyspepsia but without any red flag symptoms is either empirical treatment with a proton pump inhibitor or to test for Helicobacter pylori and treat accordingly.

If red flag symptoms are present in patients of any age, a specialist endoscopy referral is recommended.

In patients aged 55 or older with persistent, unexplained dyspepsia, an urgent referral for endoscopy should be made even if none of the above alarm symptoms are present.

For patients presenting with dyspepsia and acute, significant GI bleeding, immediate (same day) specialist referral is recommended.

Chronic condition
Other symptoms that occur with dyspepsia include epigastric discomfort, a feeling of fullness, bloating or nausea, and fatty food intolerance.

It is important to consider the cause of the dyspepsia. Peptic ulcer disease, gastro-oesophageal reflux disease and oesophagitis can cause dyspepsia, but remember that there could be a cardiac or biliary cause. It can also be experienced in patients with irritable bowel syndrome.

Dyspepsia is a common condition and its chronic, relapsing nature makes it an insufferable condition for the patient.

Possible causes

  • Peptic ulcer disease.
  • Gastro-oesophageal reflux disease.
  • Oesophagitis.
  • Cardiac disorder.
  • Gallstones.


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