WHEN AND HOW TO INVESTIGATE THE DYSPEPTIC PATIENT

When and how to investigate the dyspeptic patient is an issue that requires careful analysis and excludes dogmatic assertions. There are several key decision factors that must be considered on a case-by-case basis: who is the patient, what kind of physician cares for the patient, and what level of uncertainty are both patient and physician prepared to accept? These factors determine to a large extent whether reassurance only, a therapeutic trial, or diagnostic investigation will be carried out. The latter may also be stratified at two levels: a basic level at which the aim is to exclude major organic disease as the cause of dyspeptic symptoms and a higher level at which more complex imaging and physiologic tests would be carried out to achieve a more precise diagnosis.