Is it gastric or cancer?



YOU have probably experienced bloating, fullness, discomfort or pain in the upper area of the abdomen at some point in your life. You would have thought it was just “bad digestion” or “gastric pain” and thought nothing more of it.

In Malaysia, persons afflicted with dyspepsia have been reported to be as high as 25% among the urban population and up to 15% among the rural population.

Dyspepsia is a common problem, which can be caused by nothing at all or a variety of underlying diseases. Hence, it should not be taken lightly.


While the causes of dyspepsia are broad, four of the most common ones are:

1. Functional dyspepsia (no underlying structural or specific causes identified);

2. Peptic ulcer disease (PUD);

3. Gastroesophageal reflux (GERD); and

4. Gastric cancer.

While the majority of dyspepsia causes remain unknown, the second most common cause is PUD. One of the well-recognised causes of PUD is an organism or bacteria called Helicobacter pylori.

This organism has been identified as being responsible for gastric cancer as well as many other diseases. It is potentially reversible with antibiotic treatment – which eradicates the bacteria.

However, first, it needs to be identified, which is why it is important for seniors with regular dyspepsia to get themselves diagnosed.

This organism is spread via food and air, hence good hygiene practices play an important role in preventing disease transmission.

Other causes of PUD include medications such as Non Steroidal Inflammatory Drugs (e.g mefenamic acid or Ponstan, diclofenac sodium or Voltaren), antiplatelet agents (e.g Aspirin) and steroids (e.g. prednisolone, dexamthasone).

Last, but not least, stress is also known to induce PUD.

Although it has been found that some dyspepsia cases are caused by GERD, many experts suggest that GERD should be differentiated from dyspepsia whereby the predominant symptom is heartburn.

However, there is considerable overlap of symptoms occurring in both.

While gastric cancer has been found in less than 2% of the studied population, it is essential to recognise and identify it as quickly as possible.

Patients with dyspepsia should seek urgent medical attention if they exhibit the following alarming symptoms:

  • Unexplained loss of appetite;
  • Unintentional weight loss;
  • Difficulty swallowing;
  • Vomiting blood (haematemesis);
  • Passing out black stools (malaena);
  • Appearing pale (anemia); and
  • Abdominal mass;

as well as the following risk factors:

  • Older age;
  • Family history of gastric cancer; and
  • Certain ethnic groups (i.e. Chinese origin).


Gastric cancer occurs at any age, however it is rare among those younger than 50 years, suggesting that the incidence increases with advancing age.

Dyspepsia symptoms caused by peptic ulceration and gastro-oesophageal reflux diseases are quite rare among the elderly.

Based on a report of cancer incidences in Malaysia between 2003 and 2005, stomach cancer was reported to be more common in men rather than women, with a sharp rise among those over 60. In terms of ethnicity, it is more common among the Chinese, followed by Indians and Malays.

Generally, dyspepsia is treated with medication, followed by endoscopy and testing for Helicobacter pylori if the symptoms are persistent or if there are complications.

If you are going to see your doctor, do reveal what medications you are taking as certain medications can put you at risk of having more serious peptic ulcer symptoms such as bleeding.


Dyspepsia should not be taken lightly if:

1. You are over 50 years old, even if there are no alarming symptoms;

2. There are alarming symptoms, regardless of your age;

3. You have a family history of cancer; and

3. You are on medications such as NSAIDs, Aspirin or steroids.

Dr Zuhra Hamzah is a Senior Lecturer and Family Medicine Consultant at the Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre. Her area of interest, apart from general practice, includes women’s health and related issues.


Mahadeva S, Yadav H, Rampal S, Everett SM, Goh KL. Ethnic variation, epidemiological factors and quality of life impairment associated with dyspepsia in urban Malaysia. Aliment Pharmacol Ther. 2010; 31: 1141–51

Mahadeva S, Goh KL, Epidemiology of Functional Dyspepsia, a global perspective, World J.Gasteroenterology,2006;12;2661-6

Talley NJ, Colin-Jones D, Koch KL, Koch M, Nyren O, Stanghellini V. Functional dyspepsia. A classification with guidelines for diagnosis and management. Gastroenterol Int 1991;4:145-160

Talley NJ et al, Evaluation of Dyspepsia, Gasteroenterology 1998; 114.

Aznida Firzah Abdul Aziz, Zuhra Hamzah, Seng Fah Tong, Sukumar Nadeson,and Sharifa Ezat Wan Puteh Helicobacter pylori related dyspepsia: prevalence and treatment outcomes at University Kebangsaan Malaysia-Primary Care Centre; Asia Pac Fam Med. 2009; 8(1): 4.

National Cancer Registry, Cancer Incidence in Peninsular Malaysia 2003-2005.

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