[Diagnosis of gastroesophageal reflux disease and dyspepsia]

Prerequisite in the diagnosis of heartburn and dyspepsia is a careful medical history which has to take into account both the differential diagnosis as well as alarm symptoms necessitating immediate and more extensive diagnostic procedures. The by far most prevalent diseases are gastroesophageal reflux disease (GERD), functional dyspepsia and peptic ulcers (today overwhelmingly due to ulcerogenic drugs but less common to Helicobacter pylori). In the further diagnostic evaluation, endoscopy is the most valuable tool revealing GERD as the dominating lesion whereas ulcers become much less frequent and malignancies are rare under 50 years of age; thus, empiric therapy is an attractive strategy in such younger population. Ultrasound investigations are recommended predominantly in cases with suspected biliary disease but not in general. Apart from basic laboratory blood tests further diagnostic procedures do not play a role in the primary evaluation in this setting.