TAPESCRIPT

   

   Brendan, perhaps we should start by clearing up the confusion that surrounds the terminology.
   What do we mean by dyspepsia and is it the same as indigestion and heartburn?

   DELANEY
   Well it really depends who you talk to. Specialists have been very keen to split out
   gastroesophageal reflux disease, that is symptoms of heartburn and acid reflex, so a burning
   feeling coming up into the centre of the chest from the stomach from dyspepsia, which is more
   of pain in the centre of the stomach, just below the rib cage. Unfortunately, splitting them
   up in general practice doesn't really work very well because the individual symptoms aren't
   particularly predictive of any kind of underlying disorder and you really need to have had a
   look down with an endoscope before you can really make sense of the individual symptoms that
   the patient has.

   PORTER
   And the patients are coming to see the doctor because they've got a problem - it doesn't
   really matter which type it is I suppose. What are the main causes of dyspepsia - perhaps we
   can break them up in that way?

   DELANEY
   Well unfortunately the commonest cause is no cause found ...

   PORTER
   So often the case in medicine.

   DELANEY
   Yes exactly. Or functional dyspepsia or functional reflux disease, depending on whether
   they've got predominant heartburn or upper gastric pain. If there is a cause found then at the
   moment the most common is oesophagitis or inflammation of the gullet, part of gastroesophageal
   reflux disease and less than 10% of patients will have a peptic ulcer, either in the duodenum
   or the stomach. And then finally, on the very end, the rare causes, overall about 1% of
   patients, will turn out to have a malignancy either of the stomach or the oesophagus.