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Medical history

Key elements


  • Symptoms and signs have a low predictive value in dyspepsia and there is a considerable overlap between various conditions
  • Only 1 in 4 of patients with dyspepsia referred from a general practitioner to have upper GI endoscopy due to suspicion of peptic ulcer, ends up to have an ulcer

Localised pain

  • May indicate an ulcer

Relief of symptoms from eating and/or antacids?

  • May indicate an ulcer

Relief of symptoms only from drinking and antacids?

  • May indicate gastro-oesophageal reflux disease

Night pains?

  • May indicate an ulcer

Is the patient taking NSAIDs or salicylates?

  • May indicate gastric ulcer

Gastro-oesophageal reflux symptoms are dominating?

  • Is compatible with gastro-oesophageal reflux disease


  • May indicate gastro-oesophageal reflux disease
  • Consider oesophageal malignancy

Attacks with severe pain?

  • Consider gallstone disease

Symptoms of irritable bowel?

  • May indicate functional dyspepsia

Prominent psychosocial problems?

  • May indicate functional dyspepsia

Dyspepsia associated with myalgia?

  • May indicate functional dyspepsia

Weight loss, anorexia, anemia?

  • Malignancy should be considered

First time dyspepsia in a person older than 60 years?

  • Consider malignancy

Worried about a serious disease?

  • If the patient cannot accept your clinical diagnosis, be liberal and refer the patient to upper GI endoscopy
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