Intended for healthcare professionals

Practice 10 Minute Consultation


BMJ 2011; 343 doi: (Published 30 September 2011) Cite this as: BMJ 2011;343:d6234
  1. P A Cooke, general practice research registrar,
  2. G J Gormley, general practitioner and senior lecturer,
  3. A Gilliland, general practitioner and senior lecturer,
  4. M E Cupples, general practitioner and reader
  1. 1Department of General Practice, Queen’s University, Belfast BT9 7HR, UK
  1. Correspondence to: P A Cooke pcooke03{at}
  • Accepted 8 August 2011

A 35 year old woman attends with a three month history of a recurrent burning sensation in her upper abdomen. The symptom is worse at night and has no relation to exercise. The periods of discomfort have increased in frequency and they are no longer relieved by over the counter remedies.

What you should cover

This history is typical of dyspepsia. Self management before presenting to a doctor is common. Distinguishing between epigastric pain, heartburn, and acid reflux is unlikely to change management, but atypical or increasingly severe symptoms require consideration of other diagnoses such as angina, biliary colic, or pancreatitis.


  • Red flags in the history and examination (box)—these should be documented

  • Possibility of pregnancy, which can affect symptoms and management

  • Medical history: specifically pernicious anaemia, Barrett’s oesophagitis, intestinal dysplasia, or previous peptic ulcer surgery, as these conditions are associated with increased risk of malignancy and would lower the threshold for referral

  • Family …

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