[Endoscopy or trial treatment of patients with dyspepsia?]

The predictive value of dyspeptic symptoms is low. Upper GI endoscopy is the diagnostic gold standard, giving optimal basis for adequate drug treatment and may have a positive influence on the prognosis of non ulcer dyspepsia. Accordingly, endoscopy tends to be recommended at an early stage of chronic dyspepsia. Age above 40 years, pains relieved by food or antacids, night pains, smoking and male sex enhances the probability of an organic disease and thus the need for endoscopy. Trial treatment is recommended if the waiting period for endoscopy exceeds two weeks. Patients previously endoscoped may often be treated in accordance with earlier diagnosis and drug experience when relapsing. Drug choice when there is no firm diagnosis, should be determined by the symptom pattern. Two weeks of treatment failure necessitates endoscopy. Individual trial packages containing both the active drug and placebo could improve decision making in clinical practice.