[Dyspepsia in general medicine: current diagnostic approach]

Upper GI tract endoscopy remains a key investigation in dyspepsia. Nevertheless, since the development of non-invasive techniques for Helicobacter pylori (Hp) infection detection and the current trend for immediate prescription of anti secretary drugs in "endoscopy negative gastro-oesophageal reflux disease" (NORD), accurate indications for endoscopy must be reconsidered. Careful recording of the medical history of the patient is crucial. Personal antecedents (diseases and drugs), familial history (especially gastric cancer) must be evidenced and three symptomatic groups must be identified: patients with alarm symptom(s), typical ulcer pain and GORD. Beside those three categories, most patients must be classified in "non specific dyspepsia". Immediate endoscopy is highly recommended in all patients with either alarm symptom(s) or typical ulcer pain (except in suspected relapse of a well documented duodenal ulcer disease). Age is a key determinant in GORD: endoscopy is not necessary in patients under 45 years of age. In case of "non specific dyspepsia" in patients under 45 years, a non-invasive test for Hp infection will favour when positive endoscopic investigation ("test and scope" policy). Nevertheless, in all patients above 45 years and in all patients with either a personal history of gastric ulcer, or a familial history of gastric cancer (whatever the age), endoscopy with biopsies remains the first recommended investigation.