Etiology:
- Peptic ulcer or malignancy
- Gastro-oesophageal reflux disease (GORD)
- Hiatus hernia
- Coeliac disease ( gluten intolerance, test for IgA-transglutaminas(tTG)-antibody)
- Crohn’s disease
- Gastroparesis
- Medications: eg non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates (such as alendronic acid or risedronate), iron supplements, nitrates, levodopa
- Pancreaticobiliary disease eg gallstone disease, pancreatic malignancy
- Systemic conditions eg diabetes, Addison’s disease.
Red flags with indication for further investigation:
- Age greater than 55 with new onset dyspepsia
- Dysphagia
- Unintentional weight loss ( then order an endoscopy as soon as possible < 2 weeks)
- GI bleeding
- Trombocytose
- Persistent vomiting
- Iron deficiency anaemia
- A palpable epigastric mass
- An abnormal barium meal result
Investigation: endoscopy, if negative then CT abdomen : pancreatobiliary disease, gallstone or malignancy?
Resourses: BMJ learning
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