Dyspepsia is a common and complex condition consisting of chronic upper gastrointestinal symptoms. A rational approach to diagnosis and treatment of dyspepsia includes identifying those patients with alarm symptoms and referring them for prompt endoscopy. Those without alarm symptoms can be differentiated into patients who do and do not have symptoms consistent with gastroesophageal reflux disease. In the absence of predominant heartburn and regurgitation, patients should be tested and treated for Helicobacter pylori. Functional (nonulcer) dyspepsia is a multifactorial disorder with several possible pathophysiologic mechanisms, but no clear guidelines for therapy. There is some evidence of efficacy of proton pump inhibitors, antisecretory agents, antidepressants, and psychotherapy for functional dyspepsia.