Clinical examination is helpful for differential diagnoses (e.g., hepatomegaly suggests hepatocellular carcinoma), and in directing the investigations.
Whilst empirical treatment such as anti-acid for presumed gastritis will usually be effective, recurrent or progressive symptoms warrant further work-up.
The various procedures or imaging involved in the initial evaluation of dyspepsia or reflux may include the following (listed along with the common conditions which may be diagnosed):
OGD (oesophago-gastroduodenoscopy): oesophagitis, gastritis, ulcer, polyps or tumour may be identified and biopsy taken.
Ultrasound of the abdomen: gallbladder stones, cysts or tumours in liver or kidney, obstructed bile ducts or mass in pancreatic head.
CT scan of the abdomen & pelvis: tumours, or in solid organs (e.g., pancreas), lymphadenopathy, occult infections or lesions in spine.
Manometry & pH studies: reflux and retention of acid in the lower oesophagus, and peristalsis and tonic contractions of the oesophagus.
Barium meal: ulcers, polyps or tumours. This may be offered as an alternative to OGD, but it is not possible to perform biopsy nor test for Helicobacter pylori infection. Subtle changes including early gastric cancer may be missed.
Colonoscopy: polyps, tumours or diverticular disease.
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