Clinical and epidemiological perspectives of dyspepsia in a multiracial Malaysian population

Dyspepsia is perhaps the most common gastrointestinal disease universally. The prevalence of dyspepsia ranges from 7-40% in population based studies worldwide. These figures vary with definition of dyspepsia used and also with the survey methodology. As with Western studies, functional dyspepsia (FD) predominates in Asia. With a decline in peptic ulcer disease and gastric cancer, the proportion of FD is set to increase further. Studies have shown FD to account for 50-70% of cases of uninvestigated dyspepsia. In Malaysia dyspepsia has been reported in up to 15% of a rural and 25% of an urban population. No racial differences were seen in the rural survey. In the urban survey, Malays and Indians were found to have significantly more dyspepsia than Chinese. No clear explanation can be found for these racial differences. In clinical practice, Malays seem to complain a lot of wind and bloating in the "stomach." This is interesting to note when you compare it with the prevalence of H. pylori which is distinctly less common amongst Malays compared to the Indians and Chinese. As with many Asian populations, many Malaysians do not consult for complains of dyspepsia. Many will self medicate and others may even bear with their complains. This is probably true in the rural population. Traditional medications are often used and these are often ethnic based. Different types of lotions for example are used for massaging the putative area in the abdomen by Malay, Chinese and Indian patients. Moxibustion and acupuncture is still practiced by Chinese traditional physicians for treatment of dyspepsia. The notion that mood disorders may underlies dyspepsia is still poorly accepted by a less educated or rural population who consider a psychiatric consultation a taboo. Amongst urban dwellers where Westernized medical care is readily available and the awareness of potential serious disease like cancer is higher, consultation for dyspepsia is certainly higher. Indeed a higher education level has been identified as independent risk factors for dyspepsia in both an urban and rural population survey in Malaysia. With greater consultation for dyspepsia, there has also been a higher demand and utilization of endoscopy services for investigation of gastrointestinal diseases in the country.