A Guide to the Differential Diagnosis and Treatment of Intestinal Dyspepsia and Malabsorption

1. Dr. Samatbek Turdaliev

2. Arooj Fatima

    Kainat Amna

(Lecturer, International Medical Faculty, Osh state university, Kyrgyzstan.

Students, International Medical Faculty, Osh State University, Kyrgyzstan)

ABSTRACT

The community prevalence of dyspepsia ranges from 20% to 40%, and dyspepsia accounts for 3% to 5% of primary care visits. Dyspepsia symptoms include epigastric pain, postprandial fullness, early satiety, epigastric bloating and belching.Diagnostic symptom-based criteria are defined by Rome IV. Evaluation of functional dyspepsia is driven by patient age and the presence of red-flag symptoms, such as patients over age 60 years or those with anemia undergoing evaluation with esophagogastroduodenoscopy.Treatment options include proton pump inhibitors, neuromodulators, and prokinetics; however, the evidence supporting these therapies is weak, and the response rate is less than robust.

INTRODUCTION

Dyspepsia refers to a set of symptoms localized to the upper abdomen and is primarily a disorder of digestion rather than absorption, typically triggered or worsened by meals, with common symptoms including early satiety, postprandial fullness, upper abdominal pain or burning, bloating, belching, and nausea. In contrast, malabsorption syndromes involve impaired absorption of nutrients in the small intestine due to specific diseases and can lead to both gastrointestinal and systemic effects; symptoms may include chronic diarrhea with pale, bulky, foul-smelling, floating stools (steatorrhea), bloating, flatulence, abdominal cramping, unintentional weight loss, fatigue, weakness, and manifestations of nutrient deficiencies such as anemia, edema, easy bruising, or bone pain. A stepwise diagnostic workup begins with a detailed history and physical examination focusing on symptom patterns, stool characteristics, dietary habits, travel and family history, and signs of deficiency such as dermatitis herpetiformis in celiac disease, followed by basic laboratory tests including CBC, iron studies, vitamin B12, folate, vitamin D, albumin, calcium, magnesium, C-reactive protein, and stool tests such as fecal calprotectin, stool for ova and parasites, and fecal elastase or fecal fat to assess for pancreatic insufficiency and steatorrhea.

The Diagnostic Workup:

A stepwise approach is essential, beginning with a detailed history and physical examination to assess symptom patterns, timing, stool characteristics, dietary habits, travel history, and family history, while also looking for signs of deficiency such as dermatitis herpetiformis in celiac disease. The next step involves initial basic tests, including blood tests such as complete blood count for anemia, iron studies, vitamin B12, folate, vitamin D, albumin, calcium, magnesium, and C-reactive protein for inflammation. Stool tests are also important and may include fecal calprotectin to detect intestinal inflammation, stool examination for ova and parasites, and fecal elastase or fecal fat to evaluate for pancreatic insufficiency and steatorrhea.

CONCLUSION

For those struggling with persistent gut symptoms, understanding the difference between digestion problems (dyspepsia) and absorption problems (malabsorption) is the first step toward relief. The journey to a diagnosis may involve several tests to pinpoint the exact issue, but this process is crucial. The good news is that once identified, most causes—from food sensitivities and infections to chronic conditions—have effective management strategies. Working closely with your healthcare team to find the root cause is the most important factor in reclaiming your gut health and overall well-being.

REFERENCES 

Talley, N. J., & Ford, A. C. (2015). Functional Dyspepsia. New England Journal of Medicine, 373(19), 1853–1863.

Acomprehensive review of the pathophysiology, diagnosis, and management of functional dyspepsia, a leading cause of intestinal dyspepsia.

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., et al. (2021).160(1), 99-114.e3. Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray,

J. A. (2013). ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. American Journal of Gastroenterology, 108(5), 656–67

Hammer, H. F., Fox, M. R., & Keller, J. (2021). European Guideline on the Management of Functional Bowel Disorders and the Microbiome.

United European Gastroenterology Journal, 9(3), 287–306.