Gastroscopy is the primary investigation for dyspeptic patients who are aged more than 55 years or have alarming symptoms or use non-steroidal anti-inflammatory drugs (NSAIDs). The investigation of dyspepsia in patients aged less than 55 years should start by establishing the presence of Helicobacter pylori infection. Helicobacter-positive patients are treated with triple therapy . Before further investigations are carried out, a 2-4 week therapeutic trial with a proton pump inhibitor (PPI) is indicated in Helicobacter-negative patients aged less than 55 years whose symptoms are not suggestive of an organic disease and who do not use NSAIDs . Upper abdominal ultrasonography is not useful as a primary investigation.Don't forget the possibility of an ischaemic heart disease in a patient at risk.