Dyspepsia risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahad Hasan, M.D.[2]
Overview
Dyspepsia is a common condition, with a global pooled prevalence of approximately 8.4% (95% CI 7.4–9.5%) according to a 2024 systematic review and meta-analysis of population-based studies applying Rome I–IV criteria; prevalence is higher in women (9.0% versus 7.0% in men) and in developing countries (9.1% versus 8.0% in developed countries).[1] Risk factors for the development of dyspepsia are multifactorial and include Helicobacter pylori infection, chronic use of NSAIDs, family history of peptic ulcer disease, prior acute gastroenteritis (post-infectious dyspepsia), emotional stress and psychological comorbidity (particularly anxiety and depression), female sex, tobacco smoking, and dietary factors including increased intake of high-fiber, high-fat, and greasy foods and overconsumption of caffeine.[2][3] A large meta-analysis of population-based studies found that the prevalence of uninvestigated dyspepsia was significantly higher among women (OR 1.24), smokers (OR 1.25), NSAID users (OR 1.59), and individuals who were H. pylori-positive (OR 1.18).[3] Emerging genetic evidence from a comprehensive Mendelian randomization study additionally supports depression and gastroesophageal reflux disease as causally-linked risk factors for functional dyspepsia.[4] Less common risk factors include alcohol consumption, low body mass index/underweight status, nosocomial stress ulcers related to prolonged mechanical ventilation and coagulopathy, and rare conditions causing gastric acid hypersecretion such as Zollinger-Ellison syndrome. Age ≥60 years and the presence of alarm features (such as unintentional weight loss, gastrointestinal bleeding, dysphagia, or a family history of upper gastrointestinal malignancy) are also recognized as risk markers for underlying organic or malignant disease and warrant prompt upper endoscopy per the 2017 ACG/CAG guideline on the management of dyspepsia.[5]
Risk Factors
Risk factors for the development of dyspepsia can be categorized as common (well-established, higher-strength evidence), less common, and markers of underlying organic/malignant diseases.[6][7][8][9][10][11][12][13]
| Risk factor | Comments | Source |
|---|---|---|
| Helicobacter pylori infection | Uninvestigated dyspepsia; independent risk factor for functional dyspepsia, particularly in patients ≥64 years | [3] |
| NSAID use | Uninvestigated dyspepsia; synergistic with H. pylori for bleeding peptic ulcer (>6-fold increased risk) | [3][12] |
| Female sex | Uninvestigated dyspepsia; global pooled prevalence 9.0% (women) vs 7.0% (men) | [3][1] |
| Tobacco smoking | Uninvestigated dyspepsia | [3] |
| Prior acute gastroenteritis (post-infectious dyspepsia) | Functional dyspepsia >6 months after acute gastroenteritis | [14] |
| Depression / anxiety and psychological comorbidity | Genetically-predicted depression causally associated with functional dyspepsia; anxiety independently associated with FD | [4][15] |
| Low body mass index (underweight, BMI <18.5 kg/m²) | Independently associated with functional dyspepsia (13.3% of FD subjects vs 3.5% of controls) | [15] |
| Gastroesophageal reflux disease | Genetically-predicted GERD causally associated with increased risk of functional dyspepsia | [4] |
| Family history of peptic ulcer disease | Increased risk on population-based cohort analysis | [11] |
Common risk factors
Common risk factors in the development of dyspepsia include:
- Helicobacter pylori infection
- Chronic use of NSAIDs (including low-dose aspirin)
- Family history of peptic ulcer or upper gastrointestinal disease
- Prior episode of acute gastroenteritis (post-infectious dyspepsia)
- Female sex
- Tobacco smoking
- Eating meals too quickly or consuming too much food at meals
- Emotional stress and psychological comorbidity, particularly anxiety and depression
- Overabundance of high-fiber foods
- Overconsumption of caffeine
- Spicy, high-fat, and greasy foods
- Coexisting gastroesophageal reflux disease
Less common risk factors
Less common risk factors in the development of dyspepsia include:
- Alcohol consumption
- Psychological stress (independent of anxiety/depression)
- Low body mass index (underweight, BMI <18.5 kg/m²)
- Older age (>50–60 years)
- Nosocomial stress ulcers due to the use of mechanical ventilation for more than 48 hours, and coagulopathy
- Rare conditions associated with gastric acid hypersecretion such as:
- Zollinger-Ellison syndrome, mastocytosis, or a retained antrum following partial gastrectomy
- Gastrinoma or multiple endocrine neoplasia type I (MEN-I), antral G cell hyperplasia, basophilic leukemias, short bowel syndrome
Risk factors for underlying organic or malignant disease (alarm features)
According to the 2017 ACG/CAG Clinical Guideline on the Management of Dyspepsia, the presence of alarm features increases the pre-test probability of underlying upper gastrointestinal malignancy by 2- to 3-fold and should prompt upper endoscopy regardless of age; endoscopy is also recommended for new-onset dyspepsia in patients ≥60 years of age to exclude organic pathology, with consideration of earlier endoscopy in patients at increased gastric cancer risk (e.g., those who spent childhood in a high-incidence region or with a positive family history of gastric cancer).[5]
| Alarm feature | Clinical significance |
|---|---|
| Unintentional weight loss | Suggests underlying malignancy or organic disease |
| Gastrointestinal bleeding or iron deficiency anemia | Suggests peptic ulcer disease or malignancy |
| Progressive dysphagia or odynophagia | Suggests esophageal stricture or malignancy |
| Persistent vomiting | Suggests gastric outlet obstruction or malignancy |
| Palpable abdominal mass or lymphadenopathy | Suggests malignancy |
| Family history of upper gastrointestinal malignancy | Increases pre-test probability of malignancy |
| Age ≥60 years at symptom onset | Increases pre-test probability of malignancy; threshold for prompt endoscopy |
References
- ↑ 1.0 1.1 He J, Guo Q, Zhou J, Liu T, Wang R, Zhou Y (2024). "Global prevalence of functional dyspepsia according to Rome criteria, 1990-2020: a systematic review and meta-analysis". Sci Rep. 14 (1): 3481. doi:10.1038/s41598-024-54716-3. PMID 38378941 Check
|pmid=value (help). - ↑ Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ (2016). "Gastroduodenal Disorders". Gastroenterology. 150 (6): 1380–1392. doi:10.1053/j.gastro.2016.02.011. PMID 27147122.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Ford AC, Marwaha A, Sood R, Moayyedi P (2015). "Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis". Gut. 64 (7): 1049–1057. doi:10.1136/gutjnl-2014-307843. PMID 25147201.
- ↑ 4.0 4.1 4.2 Xu W, Zhu Y, Ma Z, Fu Z, Chen R, Zhang X (2024). "The associations between functional dyspepsia and potential risk factors: A comprehensive Mendelian randomization study". PLoS One. 19 (5): e0302809. doi:10.1371/journal.pone.0302809. PMID 38718064 Check
|pmid=value (help). - ↑ 5.0 5.1 Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017). "ACG and CAG Clinical Guideline: Management of Dyspepsia". Am J Gastroenterol. 112 (7): 988–1013. doi:10.1038/ajg.2017.154. PMID 28631728.
- ↑ Huang JQ, Sridhar S, Hunt RH (2002). "Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis". Lancet. 359 (9300): 14–22. doi:10.1016/S0140-6736(02)07273-2. PMID 11809181.
- ↑ Ballinger A, Smith G (2001). "COX-2 inhibitors vs. NSAIDs in gastrointestinal damage and prevention". Expert Opin Pharmacother. 2 (1): 31–40. doi:10.1517/14656566.2.1.31. PMID 11336566.
- ↑ Holvoet J, Terriere L, Van Hee W, Verbist L, Fierens E, Hautekeete ML (1991). "Relation of upper gastrointestinal bleeding to non-steroidal anti-inflammatory drugs and aspirin: a case-control study". Gut. 32 (7): 730–4. PMC 1378985. PMID 1855677.
- ↑ Laporte JR, Carné X, Vidal X, Moreno V, Juan J (1991). "Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding". Lancet. 337 (8733): 85–9. PMID 1670734.
- ↑ Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, Boonyapisit S, Levenstein S, Jearanaisilavong J, Atisook K, Boontong T, Theerabutr C (2003). "Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population". J Med Assoc Thai. 86 (7): 672–85. PMID 12948263.
- ↑ 11.0 11.1 Rosenstock S, Jørgensen T, Bonnevie O, Andersen L (2003). "Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults". Gut. 52 (2): 186–93. PMC 1774958. PMID 12524398.
- ↑ 12.0 12.1 Stack WA, Atherton JC, Hawkey GM, Logan RF, Hawkey CJ (2002). "Interactions between Helicobacter pylori and other risk factors for peptic ulcer bleeding". Aliment. Pharmacol. Ther. 16 (3): 497–506. PMID 11876703.
- ↑ Everhart JE, Byrd-Holt D, Sonnenberg A (1998). "Incidence and risk factors for self-reported peptic ulcer disease in the United States". Am. J. Epidemiol. 147 (6): 529–36. PMID 9521179.
- ↑ Futagami S, Itoh T, Sakamoto C (2015). "Systematic review with meta-analysis: post-infectious functional dyspepsia". Aliment Pharmacol Ther. 41 (2): 177–188. doi:10.1111/apt.13006. PMID 25348873.
- ↑ 15.0 15.1 Beh KH, Chuah KH, Rappek N, Mahadeva S (2021). "The association of body mass index with functional dyspepsia is independent of psychological morbidity: A cross-sectional study". PLoS One. 16 (1): e0245511. doi:10.1371/journal.pone.0245511. PMID 33497382 Check
|pmid=value (help). Vancouver style error: initials (help)