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Canadian Journal of Gastroenterology
Volume 16, Issue 9, Pages 635-641

Etiology of Dyspepsia: Implication for Empiric Therapy

Richard H Hunt,1 Carlo Fallone,2 Sander Veldhuyzen van Zanten,3 Phil Sherman,4 Nigel Flook,5 Fiona Smaill,1 Alan BR Thomson,6 and the Canadian Helicobacter Study Group

1Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
2Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Quebec, Canada
3Division of Gastroenterology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
4Division of Gastroenterology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
5Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
6Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Received 11 February 2002; Accepted 19 July 2002

Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Dyspepsia describes a symptom complex thought to arise in the upper gastrointestinal tract and includes, in addition to epigastric pain or discomfort, symptoms such as heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Based on the evidence that heartburn cannot be reliably distinguished from other dyspeptic symptoms, the Rome definition appears to be too narrow and restrictive. It is particularly ill suited to the management of uninvestigated dyspepsia at the level of primary care. In patients presenting with uninvestigated dyspepsia, a symptom benefit is associated with a ‘test and treat’ approach for Helicobacter pylori infection. A substantial proportion of those who do not benefit prove to have esophagitis on endoscopy. In those with functional dyspepsia, the benefits of H pylori eradication, if any, appear to be modest. Hence, a "symptom and treat" acid-suppression trial with proton pump inhibitors, and a ‘test and treat’ strategy for H pylori are two acceptable empirical therapies for patients with univestigated dyspepsia.