Can dyspeptic symptoms predict the underlying cause of dyspepsia?
Individual dyspeptic symptoms or subgroups of symptoms, such as predominant epigastric pain (ulcer-like) or discomfort (dysmotility-like), poorly predict the presence of underlying organic lesions. A systematic review found that neither primary care doctors nor gastroenterologists could distinguish patients with organic lesions from those with functional dyspepsia on the basis of symptom evaluation.11 However, the presence of predominant heartburn and regurgitation may help predict underlying gastro-oesophageal reflux disease. A well conducted clinical study, where 371 patients underwent 24 hour oesophageal pH monitoring, showed that predominant heartburn or regurgitation were good predictors of pathological gastro-oesophageal reflux.12 International guidelines support the view that uninvestigated patients with dyspeptic symptoms and predominant heartburn or regurgitation can be considered to have gastro-oesophageal reflux disease1 4 5 6 7; conversely, patients with predominant epigast
