The full content of Annals is available to subscribers

Subscribe/Learn More  >
Investigating Selected Symptoms |


Peter Bytzer, MD, PhD; and Nicholas J. Talley, MD, PhD
[+] Article, Author, and Disclosure Information

From the University of Sydney and Nepean Hospital, Sydney, Australia. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Requests for Single Reprints: Nicholas J. Talley, MD, PhD, Department of Medicine, University of Sydney, Nepean Hospital, Clinical Sciences Building, Box 63, Penrith, NSW 2751, Australia; e-mail, ntalley@blackburn.med.usyd.edu.au.

Current Author Addresses: Dr. Bytzer: Department of Medicine M, Division of Gastroenterology, Glostrup University Hospital, DK-2600 Glostrup, Denmark.

Dr. Talley: Department of Medicine, University of Sydney, Nepean Hospital, Clinical Sciences Building, Box 63, Penrith, NSW 2751, Australia.

Ann Intern Med. 2001;134(9_Part_2):815-822. doi:10.7326/0003-4819-134-9_Part_2-200105011-00004
Text Size: A A A

Dyspepsia refers to pain or discomfort centered in the upper abdomen. This symptom is remarkably common, with 1-year prevalence rates averaging 25% in the community. Symptoms suggestive of the irritable bowel syndrome and reflux disease frequently overlap but do not form part of the definition of dyspepsia. Electrical and other stimuli can cause similar or different symptoms in various patients, and even the site to which symptoms are referred varies considerably. Dyspeptic symptoms are therefore a relatively poor guide to the origin or nature of any “disturbances” in the gut. Identification of patients who require further investigation to rule out serious structural disease, such as peptic ulcer disease or cancer, is a key issue because unaided clinical diagnosis is unreliable. The use of an age threshold (typically 45 years) and the identification of alarm features, including weight loss, repeated vomiting, and signs of bleeding, seem to be valid on the basis of the limited evidence available. Dyspeptic symptoms fall into distinct subgroups resembling the perceived clinical entities of ulcer-like and dysmotility-like dyspepsia. Unfortunately, because of overlap with reflux symptoms and between the subgroups, the clinical significance of these groups remains highly questionable. A focus on symptom predominance may be more rewarding. Lack of validated outcome measures has hampered clinical studies and has led to the development of complex outcome measures that integrate and weigh different symptoms or other indirect indicators of outcome into a general score. Further testing and validation are in progress.




Grahic Jump Location
Figure 1.
Dyspepsia symptoms associated with impaired gastric accommodation.gray barswhite bars*P[39]

Early satiety and weight loss greater than 5% of initial body weight were significantly more prevalent in patients with impaired accommodation to a meal ( ) than in patients with normal accommodation ( ).  < 0.05. (Reproduced with permission from Tack et al. . Gastroenterology. 1998;115:1346-52.).

Grahic Jump Location
Grahic Jump Location
Figure 2.
The prevalence, at presentation, of alarm features for gastrointestinal cancer in 169 patients younger than 55 years of age in whom gastric or esophageal cancer was diagnosed.topbottom[47]

All 73 patients with esophageal cancer ( ) and 71 of 76 patients with gastric cancer ( ) had at least one alarm symptom at presentation. Weight loss was defined as loss of more than 3 kg in 6 months. Anemia was defined as a hemoglobin concentration less than 100 g/L in women and less than 120 g/L in men. (Reproduced with permission from Gillen and McColl . Am J Gastroenterol. 1999; 94:75-9.).

Grahic Jump Location
Grahic Jump Location
Appendix Figure. Diagrams show regions of referred pain during stimulation of the prepyloric region ( ), the greater curvature ( ), the lesser curvature ( ), and the duodenal bulb ( ). The variability in the area of referred pain emphasizes that gastric and duodenal lesions can be found in patients with a variety fo abdominal pain symptoms. (Reproduced with permission from Drewes et al. , Gut. 1997; 41:753-7.)
Areas of referred pain during repeated electrical stimuli delivered to the stomach by biopsy forceps during gastroscopy of healthy volunteers.top lefttop rightbottom leftbottom right[4]
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.