Upper GI complaints include chest pain (see Symptoms of Cardiovascular Disorders: Chest Pain), chronic and recurrent abdominal pain, dyspepsia, lump in the throat, halitosis (see Symptoms of Dental and Oral Disorders: Halitosis), hiccups, nausea and vomiting, and rumination. Some upper GI complaints represent functional illness (ie, no physiologic cause found after extensive evaluation).

History: Using open-ended, interview-style questions, the physician identifies the location and quality of symptoms and any aggravating and alleviating factors. Psychologic stress factors must be specifically sought. Because a psychiatric disorder does not preclude physiologic disease, the significance of vague, dramatic, or bizarre complaints should not be minimized.

Patients report symptoms differently depending on their personality, the impact of the illness on their life, and sociocultural influences. For example, nausea and vomiting may be minimized or reported indirectly by a severely depressed patient but presented with dramatic urgency by a histrionic one.

Physical examination: Inspection of the abdomen with the patient supine may show a convex appearance when bowel obstruction, ascites, or, rarely, a large mass is present. Auscultation to assess bowel sounds and determine presence of bruits should follow. Percussion elicits hyperresonance (tympany) in the presence of bowel obstruction and dullness with ascites and can determine the span of the liver. Palpation proceeds systematically, beginning gently to identify areas of tenderness and, if tolerated, palpating deeper to locate masses or organomegaly. Digital rectal examination with testing for occult blood and (in women) pelvic examination complete the evaluation of the abdomen.

Testing: Patients with acute, nonspecific symptoms (eg, dyspepsia, nausea) and an unremarkable physical examination rarely require testing. Findings suggesting significant disease (alarm symptoms) should prompt further evaluation:

• Anorexia
• Anemia
• Blood in stool (gross or occult)
• Dysphagia
• Fever
• Hepatomegaly
• Pain that awakens patient
• Persistent nausea and vomiting
• Weight loss

Chronic or recurrent symptoms, even with an unremarkable examination, also warrant evaluation. Specific GI tests are discussed in Diagnostic and Therapeutic GI Procedures.

Last full review/revision March 2008 by Norton J. Greenberger, MD

Content last modified March 2008