Dyspepsia is common: uninvestigated dyspepsia affects approximately 20.8% of the general population under broad definitions, while functional dyspepsia has a global pooled prevalence of approximately 8.4% according to a 2024 systematic review and meta-analysis 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, smokers, NSAID users, and individuals who were H. pylori-positive.^[3] A single Mendelian randomization study provides emerging, genetically-supported evidence for depression and gastroesophageal reflux disease as risk factors for functional dyspepsia; this inference rests on genetic-instrument assumptions and requires replication.^[4] The relationship with body mass index is bidirectional: higher BMI is the more consistent independent predictor of incident functional dyspepsia in longitudinal and large global data, while underweight/leanness is associated with functional dyspepsia in several Asian and primary-care cohorts, and a U-shaped relationship confined to women has been described. Alcohol consumption is a less consistent association. Age ≥60 years is the dominant risk marker for underlying organic or malignant disease and, per the 2017 ACG/CAG guideline, warrants upper endoscopy; alarm features (unintentional weight loss, gastrointestinal bleeding, dysphagia, persistent vomiting, family history of upper GI malignancy) raise concern but do not by themselves mandate endoscopy in patients under 60.^[5]

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]}

Common risk factors in the development of dyspepsia include:

• Psychological comorbidity is the strongest risk association: baseline anxiety conferred an ~8-fold higher odds of developing FD in a Swedish population survey, and the gut–brain relationship is bidirectional (anxiety/depression precede FD, and FD predicts later anxiety/depression).^[17]
• 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
• Overabundance of high-fiber foods
• Overconsumption of caffeine
• Spicy, high-fat, and greasy foods
• Coexisting gastroesophageal reflux disease
• Downgrade note: meal-related dietary factors (high-fat/greasy, spicy, high-fiber foods, caffeine) are better characterized as symptom triggers and primary-prevention targets than as validated risk factors for the development of functional dyspepsia; see primary prevention.

Less common risk factors in the development of dyspepsia include:

• Alcohol consumption
• Psychological stress (independent of anxiety/depression)

According to the 2017 ACG/CAG Clinical Guideline, the presence of alarm features confers a 2- to 3-fold relative increase in the pre-test probability of upper gastrointestinal malignancy, but the absolute risk in patients under 60 remains well below 1%, and the guideline conditionally recommends against upper endoscopy on the basis of alarm features alone in this age group. Alarm features have a low positive predictive value for GI cancer (<11%) with a high negative predictive value (>97%). Upper endoscopy is recommended for new-onset dyspepsia in patients ≥60 years, with a lower threshold in those at increased gastric cancer risk (childhood in a high-incidence region, family history of gastric cancer, male sex) and, on a case-by-case basis, in patients <60 with prominent or combined alarm features (e.g., weight loss >20 lb, rapidly progressive dysphagia).^[5][19][20]

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