Undiagnosed dyspepsia significantly affects young adults, particularly university students, and impacts their academic performance, well-being, and long-term health [18]. In this study, we found a relatively high prevalence of UD among undergraduate health program students at Makerere University, with several associated factors, including protective ones like black tea consumption and physical activity, while coffee intake, irregular eating patterns, alcohol use, fatigue, underweight BMI, and longer sleep duration increased risk. Although UD was common, no significant association with quality of life was observed.

Prevalence of UD among undergraduate health program students

The prevalence of UD among undergraduate health program students in this study was 13.5% (95% CI: 10.2–17.4%). This estimate is lower than the 46% reported among medical students at Kampala International University in Western Uganda [6]. This is possibly due to methodological differences, as the latter study employed a broader definition that included any gastrointestinal disorder, regardless of symptom duration. Conversely, our prevalence was higher than the 5.7% reported among college students in China [19]. This difference may be attributed to variations in study populations. This study focused on health program students, who are more prone to stress and irregular lifestyles, unlike the Chinese study, which included students from various academic programs. Our results are comparable to a European study that reported a 10.9% prevalence among foreign medical students [20], probably due to shared predisposing factors such as high fatigue levels. Overall, these findings show that a substantial proportion of health program students experience UD, with potential consequences for academic performance, well-being, and long-term health.

Factors associated with UD among undergraduate health program students

Taking black tea daily or on some days significantly reduced the prevalence of UD by 60% and 70%, respectively. These findings align with a prospective cohort study, which reported that consuming one to two cups of black tea per day reduced the risk of UD by 66% [21,22,23]. This protective effect may be due to black tea’s ability to stimulate beneficial intestinal bacteria and suppress harmful microorganisms, thereby improving gut health [24]. Similarly, students who engaged in high physical activity had a 60% lower prevalence of UD compared to those with low activity. These results are consistent with a study in Australia that found regular high physical activity reduced UD risk by 35% [25, 26]. Exercise may alleviate dyspeptic symptoms by reducing gastric acid reflux, enhancing intestinal gas transport, and suppressing the production of inflammatory cytokines [26,27,28]. In contrast, a study among pre-clinical students in the United Arab Emirates showed no significant association, possibly due to a small sample size [29].

Coffee consumption was associated with a higher prevalence of UD, with occasional drinkers showing a 2.49-fold increased risk compared to non-drinkers. This finding is consistent with a multicenter survey in Latin America, which found that UD prevalence was 51% higher among coffee consumers [18, 30, 31]. This is likely due to coffee’s stimulatory effect on gastric acid secretion and subsequent gastric irritation [32]. However, the results contrast with those of a cross-sectional study conducted among 3,362 adults in Iran, and the discrepancy may be due to variations in the study populations [33]. Eating two meals a day was associated with a 2.64 times higher prevalence of UD compared to those who had one meal a day. This finding aligns with a multicenter survey conducted among four Latin American schools [5].This may be a result of reserve causation, where those with UD modify their eating patterns to alleviate symptoms. However, the results contradict with findings of the study conducted among 3,362 adults in Iran [34].The discrepancy is likely due to variations in the study population and the diagnostic tool used for dyspepsia, as the latter study was conducted in the community and utilised Rome III criteria. Consequently, this finding should be considered exploratory and hypothesis-generating, warranting confirmation in longitudinal studies using standardized diagnostic criteria.

Alcohol intake increased risk as well, with low-risk drinkers experiencing an 80% higher prevalence compared to abstainers. Similarly, a narrative review found that alcohol consumption was associated with an increased risk of H. pylori infection, which is a contributor to dyspepsia [35].The low concentrations of alcohol are mild stimulants of acid secretion, which may predispose to UD, whereas at higher concentrations, it has either no or a mild inhibitory effect [36,37,38]. Other significant factors included moderate fatigue, which increased prevalence by 80%. This finding aligns with a prospective cohort study conducted in a tertiary hospital in Greece, which found a significant association between UD and fatigue [39]. Fatigue is associated with low-grade inflammation marked by elevated cytokines like IL-6 and TNF-α, which later influence behaviours such as irregular eating, poor nutrition, and inactivity, which are known risk factors for UD [39].

Underweight was also associated with a 2.2-fold higher prevalence. Similarly, Japanese university students that were underweight had a significantly higher prevalence of UD compared to those with normal BMI [40]. Since UD causes weight loss, this may be the possible reason for the significant association between BMI and UD [41]. Sleeping seven or more hours daily showed a 90% higher prevalence. Similar findings were reported in Korea, where UD was associated with poorer sleep quality and greater daytime sleepiness [42]. Prolonged sleep may be a consequence of dyspeptic symptoms, as dyspepsia can increase sleep latency and nighttime awakenings, leading to non-restorative sleep and longer time in bed [43, 44].

Relationship between QoL and UD

There was no significant relationship between QoL and UD. This implies that, despite undergraduate health program students with UD having a slightly lower mean total QoL compared to those without UD, this study could not conclusively attribute the reduction in QoL to UD, probably because the standard diagnostic tool (endoscopy) was not used to diagnose dyspepsia.

These results are different from the findings of a hospital-based study among 324 dyspeptic patients, and the discrepancy may be due to differences in the study population [45]. Hospital patients are likely to have more severe and persistent symptoms and, hence more likely to report impaired QoL, while students may tolerate mild symptoms, underestimating their impact on their QoL.

Additionally, the differences may be due to the tools used to diagnose dyspepsia, where the study conducted among dyspeptic patients in Nigeria used endoscopy to diagnose dyspepsia, whereas our study utilised Rome IV criteria, hence chance of information bias in our study, which would have distorted the findings [46].

Strengths and limitations

Variables were collected using globally valid tools by well-trained research assistants with certificates of good clinical practice. Likely confounders were adjusted for in the multivariate analysis and the sample size was adequate to increase generalization of findings to other public institutions.

The findings of this study may have been influenced by some limitations. Information bias may have arisen from recall errors regarding symptom duration, food expenditure, eating patterns, and socially desirable responses, such as reporting non-smoking status. Misclassification was also possible, given the limited sensitivity of the Rome IV criteria for diagnosing UD (75%) and potential differences in how participants assessed symptom severity and quality of life. Random error may have occurred due to sparse data in variables such as smoking, marital status, employment, and sponsorship, which reduces the power to detect true associations, particularly when smoking is excluded from the analysis entirely. Residual confounding cannot be ruled out, as factors such as academic pressure and menstrual-related gastrointestinal symptoms were not adjusted for, which may explain why variables like sex and academic program were not significant at multivariate analysis. Finally, the results may not be generalizable to rural settings or private institutions since the study was conducted in an urban public university.

Conclusion and recommendation

The prevalence of UD among undergraduate health program students was moderate, with up to 1 in 7 students. Factors significantly associated with UD included black tea, coffee, alcohol drinking, physical activity, fatigue, BMI, food frequency, and sleep hours. There was no significant relationship between QoL and UD. Undergraduate health program students should seek timely medical management for gastrointestinal symptoms, engage in regular physical activity, and limit their consumption of black tea to less than that of alcohol and coffee. University administrators should provide free services, such as endoscopy, at the university hospital to identify and manage dyspepsia among students and should also design strategies to increase student engagement in physical activity. Further studies are recommended, specifically among undergraduate health program students, to investigate the relationship between UD and QoL using standard diagnostic procedures for dyspepsia, such as endoscopy.