BACKGROUND: Dyspepsia is a common complaint in clinical practice. In the majority of cases this symptom will result from gastrooesophageal reflux or peptic inflammation or ulceration; however, upper gastrointestinal malignancy may present in a similar way. OBJECTIVE: The article aims to assist the general practitioner in determining which patients presenting with dyspepsia warrant further investigation. DISCUSSION: Patients over the age of 40 years with recent, new symptoms and those with dysphagia, weight loss, early satiety, iron deficiency anaemia, or more obvious signs such as a palpable epigastric mass or liver enlargement, require investigation in the first instance with endoscopy. In patients without these 'alarm features' it is reasonable to treat acid reflux symptoms with appropriate proton pump inhibitor therapy and only investigate in the event of inadequate symptomatic response. Those with symptoms suggestive of gastritis or duodenitis can be noninvasively tested for Helicobacter pylori infection and re-assessed after successful eradication has been confirmed.