How should new-onset dyspepsia be managed in general and specialist practice?

Managing patients with new-onset dyspeptic symptoms represents a real chall enge in clinical decision-making The major controversy has been over the op timal management strategy of patients with new-onset dyspeptic symptoms who do not present with alarm symptoms. Since unaided clinical diagnosis is un reliable, proposed management strategies have included empirical treatment algorithms, computer-assisted predictive score models and Helicobacter pylo ri-based strategies such as test-and-scope or test-and-treat algorithms. En doscopy remains the diagnostic 'gold standard', and the management should i deally be based on endoscopic diagnosis. Because of economic constraints an d increasing waiting lists, this is not possible. When precise and comprehe nsive guidelines have been formulated, future patients will probably be man aged in primary care by a Helicobacter test-and-treat policy, leaving only empirical treatment failures for specialist evaluation.