Dyspepsia is a common symptom that affects 40% of the UK adult population each year. It is estimated that only 2% of these patients consult their GP. The combined cost to the NHS of prescription medications and endoscopies is roughly £600 million annually. The majority of patients with dyspepsia are managed in the community. This article aims to provide a management approach to those who can be safely treated in the community and to revise those features in the history and examination that suggest a more serious pathology, thereby enabling identification of those requiring secondary care input.