ABSTRACT
Symptoms originating in the gastrointestinal tract (GIT) are often vague, misleading and unreliable for the purpose of reaching a diagnosis. The frequency of dyspeptic symptoms in primary care that it is unrealistic to send all patients for specialist investigations such as oesphagoscopy and gastroscopy. Indeed, 60% of the limited number of patients who are referred for 'scoping' have no identifiable pathology and are classified as having 'functional dyspepsia.' Although upper GIT presenting symptoms are often vague, careful history taking will usually 'sharpen' the evidence, sometimes sufficiently to allow definitive treatment. In the case of full-dose proton pump inhibitors (PPI), the particular reason for caution is that PPIs will temporarily heal not only benign peptic ulcers, but also gastric mucosa ulcerated by a pre-malignant or malignant growth. Over 90% of gastric ulcers and duodenal ulcers are associated with Helicobacter pylori colonization of the stomach, and eradication of Helicobacter pylori is curative in the large majority of these ulcers.
