Dyspepsia means indigestion. It’s very common, but not a very exact diagnosis.
GERD is when acid that’s normally in the stomach refluxes up into the esophagus (“food pipe”), which isn’t built to handle it (see Diagram — Gastrointestinal System). It happens if the tight sphincter muscle at the bottom of the esophagus weakens a little. This is “heartburn,” a sour taste in the mouth, but also burning, pressure, or simply pain in the chest. It may be worse when lying down (like at night), since gravity helps avoid it in upright positions. It’s often worse after meals, and can be associated with bloating.
Both GERD and Dyspepsia can cause upper abdominal pain or discomfort, general abdominal pain or discomfort, and/or chest pain. GERD can also cause a chronic sore throat or a chronic cough.
Both Dyspepsia & GERD are usually easy to treat. But our main concern has to deal with diagnosis. A person with abdominal pain may have something more serious, like ulcer, gastritis, or rarely cancer. Or even a Heart Attack; it can be difficult to tell the difference between pressure in the belly & in the heart. Similarly, a person with “chest pain,” who’s afraid they’re having a heart attack, may simply have Dyspepsia or GERD.
Actually, we only worry about heart disease the very first time a patient has pain in the chest or upper abdomen. Once it’s been going on for days, weeks, months, or years, we know we’re dealing with a disease of the digestive system. GERD is easy to diagnose if there are symptoms of heartburn.
There are no simple tests to diagnose GERD. If treatment doesn’t help, we refer to a Gastroenterologist to perform endoscopy (looking into the esophagus & stomach). That doesn’t diagnose GERD, but can find complications such as esophageal ulcers or cancer. The test to prove GERD involves placing an acid monitor in the throat for a day, which can be uncomfortable, & isn’t even 100% for sure. It’s usually only done if symptoms absolutely can’t be controlled, especially if surgery may be an option. Endoscopy is always done for patients who feel like food gets stuck as they swallow, to rule out esophageal cancer.
Dyspepsia is much more common than ulcer and gastritis, but it can be hard to tell the difference. If there are no danger signs like bleeding, weight loss, or severe pain, we usually treat without doing tests, since the same classes of antacid medications work for all these conditions. But the strongest one of them, proton pump inhibitors, can also ease the pain of stomach cancer. For patients over 50 with new abdominal pain, we refer for endoscopy instead of just treating.
For younger patients who don’t improve with medication, we also do endoscopy. But sometimes we test for a common stomach bacteria, H. pylori, & give a course of antibiotics if the test is positive. That way we can sometimes avoid endoscopy, though there’s no proof that H. pylori causes Dyspepsia the way it causes ulcers & gastritis. And it might even help prevent GERD.
Among patients with cough lasting over a month, and a normal chest x-ray, 99% will have one of the following conditions: