1. Indigestion

2. Encompasses N/V, heart burn, regurgitation, dyspepsia
Most common causes are gastroesophageal acid reflux and functional dyspepsia
-LES tone reduced: caffeine, tobacco, ethanol
-nitrate, CaCB, theophylline, progesterone
Gastric motor dysfunction
Impaired gastric fundus relaxation after eating may underlie selected dyspeptic symptoms like bloating, nausea, and early satiety.
Visceral afferent hypersensitivity
Other
-H. pylori, Psychogenic

3. Gastroesophageal Reflux
Gastroesophageal reflux can result from a variety of physiologic defects.
Reduced lower esophageal sphincter (LES) tone is an important cause of reflux in scleroderma and pregnancy
Many individuals exhibit frequent transient LES relaxations during which acid or nonacidic fluid bathes the esophagus.
Overeating and aerophagia can transiently override the barrier function of the LES, whereas impaired esophageal body motility and reduced salivary secretion prolong fluid exposure.
The role of hiatal hernias is controversial—although most reflux patients exhibit hiatal hernias, most individuals with hiatal hernias do not have excess heartburn.

4. DDx.
GERD
Functional dyspepsia (postprandial fullness, early satiety, epigastric pain or burning)
Ulcer dis. 15–25% of cases of dyspepsia stem from ulcers of the stomach or duodenum
Malignancy
Biliary colic
Extra peritoneal: CHF, TB

5. Functional Dyspepsia
Nearly 25% of the populace has dyspepsia at least 6 times yearly
10–20% of these individuals present to physicians
Functional dyspepsia, the cause of symptoms in 60% of dyspeptic patients, is defined as 3 months of bothersome postprandial fullness, early satiety, or epigastric pain or burning with symptom onset at least 6 months before diagnosis in the absence of organic cause.
Most cases follow a benign course, but some patients with H. pylori infection or on nonsteroidal anti-inflammatory drugs (NSAIDs) develop ulcers.
As with idiopathic gastroparesis, some cases of functional dyspepsia result from prior gastrointestinal infection.

6. Alarming feature Unexplained weight loss Recurrent vomiting
Occult organ GI bleeding
Jaundice
Palpable mass or LAP
Odynophagia
Family history of GI malignancy

7. Diagnostic test
Endoscopy: atypical symptoms, no response to acid-suppressing Tx., alarm factors, >55 Y, >50 y in duration, (NSAID),
Heartburn <5 years in duration, especially in patients <50 years old, endoscopy is recommended to screen for Barrett's metaplasia
Ambulatory PH testing in refractory to Tx.
Bernstein test