• Dyspepsia is identified from its characteristic features and exclusion of other causes of epigastric pain; principally biliary and cardiac disease [Neale, 2003].
• Characteristic features of dyspepsia:
• Upper abdominal discomfort or pain which may be described as a burning sensation, a heaviness, or an ache. It is often accompanied by symptoms such as nausea, fullness in the upper abdomen, or belching. Symptoms are characteristically improved by antacids and may be relieved, or worsened, by food.
• Epigastric tenderness on palpation.
• Endoscopy is rarely required to confirm dyspepsia as the cause of symptoms.
• Excluding biliary disease [Summerfield, 2003]:
• Upper abdominal discomfort or pain localized to the epigastrium or right hypochondrium. Symptoms may be precipitated by a large or fatty meal. Nausea and vomiting may be prominent with sudden biliary obstruction.
• Jaundice with associated pale stools and dark urine occurs with prolonged biliary obstruction. Fever and rigors are associated with infection of the biliary tract.
• Tenderness on inspiration, with palpation of the right hypochondrium, is characteristic.
• Where there is doubt, consider arranging investigations such as liver function tests and an abdominal ultrasound scan.
• Excluding cardiac disease [Hampton, 2003]:
• Pain is typically central and squeezing in nature and may radiate up into the neck or down the arm. Pain is often associated with breathlessness.
• Where there is doubt consider arranging confirmatory investigations.

[NICE, 2005]