Dyspepsia surgery

Surgery for dyspepsia is reserved for a small but important subset of patients with well-defined structural disease — principally peptic ulcer disease complicated by perforation, haemorrhage, obstruction, or medical intractability — and, in highly selected cases, for medically refractory symptoms attributable to disordered gastric neuromuscular function. Critically, contemporary guidelines from the British Society of Gastroenterology (BSG) explicitly state that surgery should be avoided in patients with severe or refractory FD, in order to minimise iatrogenic harm, given the absence of high-quality evidence for benefit and the recognized risk of worsening symptoms post-operatively.^[1] The substantial reduction in elective peptic ulcer surgery over recent decades is directly attributable to the discovery of Helicobacter pylori and the development of effective proton pump inhibitor (PPI) and eradication therapies.

Surgical intervention in dyspepsia is predominantly indicated for organic complications of peptic ulcer disease rather than for FD per se. Recognised indications include:

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