A 35 yo smokerman presents at morning to the ED. He refers epigastric pain since seven days. The pain worses after eating, he refers nausea without vomit and he denies melena and weight loss.
Palpation causes pain in epigastric region, there’s not fever, nor tachicardia, hemoglobin is 13 g/dL.
Bedside US evidences a normal gallblader.

Take antiacid said my doctor and don’t smoke – he says – I’m worried, Is it an ulcer? I wish to consult a gastroenterologist.

Conclusion

It’s well known that dyspepsia is one of the most frequent symptoms in ED.
Differential diagnosis between organic and functional dyspepsia based on symptoms and clinical examination assessed either by a gastroenterologist or others has a little weight.
And so?

Shall we prescribe an endoscopy?

Bibliography

Moayyedi P
Can the clinical history distinguish between organic and functional dyspepsia?
JAMA 2006 vol 295 n 13pag 1566

Talley NJ
Guidelines for the management of dyspepsia
Am J gastroenterol 2005 vol 100 pag 2324-2327