Clinically, dyspepsia refers to a group of symptoms manifesting as upper abdominal discomfort, pain and upper abdominal distention, often aggravated after meals and accompanied by early satiety, loss of appetite, nausea or vomiting. These symptoms are mainly a group of indigestion symptoms that are mainly stomach-based. Indigestion is a very common condition, the prevalence reported in various countries is between 20% and 49%, according to China Guangzhou reported that the number of patients with indigestion accounted for 11% of the number of general outpatients, accounting for 53% of the number of digestive outpatients. Indigestion obviously affects the life and work of patients. According to the etiology, dyspepsia can be divided into organic dyspepsia (OD) and functional dyspepsia (FD). The former can show relevant etiology by relevant examination, such as peptic ulcer, erosive gastritis, esophagitis and malignant diseases; it also includes abnormal digestive function caused by systemic diseases, such as diabetic dyspepsia and progressive systemic scleroderma. In contrast, patients with FD fail to show structurally significant abnormalities by endoscopy and other examinations, or have difficulty explaining their symptoms by these manifestations. Dyspepsia is quite common (20% to 54%) and seriously affects the quality of life of patients, who often make multiple visits at great expense, and has attracted close attention both at home and abroad. A 2-year survey of 3001 FD patients in Classen, Germany, showed that the quality of life of FD patients was significantly reduced; after 1 year of follow-up, 75% of the patients’ quality of life returned to normal, indicating that most FD patients have a good prognosis. The study also showed that there was little difference in outcomes between choosing to perform endoscopy after or choosing empirical treatment at the outset. This study further suggests that the development of a consultation and treatment process for dyspepsia is necessary to enable patients to receive timely diagnosis and reasonable treatment, while reducing unnecessary tests and the financial burden on patients. At present, the international diagnosis and treatment process of dyspepsia has been developed, therefore, it is necessary to develop the diagnosis and treatment process and guidelines of dyspepsia suitable for our situation. 1, the international diagnosis and treatment process of dyspepsia In 1998, Talhy pointed out in the Geneva meeting on the diagnosis and treatment process of dyspepsia that the cases of dyspepsia without investigation should be handled accordingly according to the medical history, such as anti-reflux treatment for patients with heartburn, and treatment of combined irritable bowel syndrome (IBS) according to IBS. If the patient has alarm symptoms such as dysphagia, vomiting blood, black stool and wasting, endoscopy should be performed first and then treated accordingly. For those without alarm symptoms, H. pylori should be examined or observed and then evaluated. If HP is negative, the patient should be treated with acid suppressant or prokinetic agent. Talley proposed at the 2000 Asia-Pacific Digestive Annual Meeting that patients with dyspepsia without alarm symptoms and under 50 years of age can be treated empirically, i.e., patients with ulcer-like dyspepsia can be treated with acid suppressant (proton pump inhibitor); patients with dyskinesia-like dyspepsia are treated with prokinetic agent. If the above treatment is ineffective, drug therapy can be interchanged, i.e., those who are ineffective with acid suppressant therapy receive prokinetic therapy, and those who are ineffective with prokinetic therapy receive acid suppressant therapy. However, he also believes that endoscopy is useful to explain the condition to patients. 2.The diagnosis and treatment process of dyspepsia in China The prevalence of gastric cancer in China is higher than that in the West, and further examination should be done when dyspepsia with alarm symptoms is encountered. Family history of tumor should be paid attention to, and age above 40 years old should be used as reference, but it should be closely combined with clinical. Patients with obvious emotional factors or psychological disorders should have relevant examinations in time, which is more favorable for clear diagnosis and explanation of the disease. If the patient does not have the above conditions and is in good general condition, or has received the relevant examination in the past and the symptoms have recently recurred, or cannot receive the relevant examination for the time being, dyspepsia can be treated empirically. Empirical treatment should be combined with the symptom characteristics of dyspepsia and the relationship between symptoms and meals to speculate on its possible pathophysiological basis. Gastroduodenal motility in healthy people during the interdigestive period is characterized by migratory complex motility (MMC), in which MMC III plays an important role as a “scavenger”. After the meal, the proximal stomach is adaptively dilated to accommodate the food, while the distal stomach digests the food by contraction and peristalsis, turning it into fine particles. The coordinated movement of the gastric sinus, pylorus and duodenum also plays an important role in the emptying process. Many studies have shown that gastric motility dysfunction is the main pathogenesis of FD. abnormal gastric, pyloric and duodenal motility is not only present during the digestive phase but also during the interdigestive phase in FD patients. more than 50% of FD patients have delayed gastric emptying, and in some cases, although there is no abnormal gastric emptying, the distribution of food in the stomach after meals is abnormal. Impairment of postprandial fundic relaxation or abnormal sensation of dilation may be associated with early satiety. About 50% of FD patients have hypersensitivity of the stomach and duodenum to mechanical stimuli, which could explain the ease of epigastric fullness symptoms in FD patients despite the small amount of food eaten. In addition, reduced duodenal acid clearance due to duodenal motility disorder is associated with nausea. the basis of FD patients’ symptoms during fasting may be their abnormal MMC III activity, including reduced number of MMC III appearances, reduced MMC II motility and duodenogastric reflux, etc. These may explain that some patients have symptoms during fasting and do not reduce or even worsen after meals. Patients are often afraid to eat more to avoid aggravating their symptoms. Focusing on the relationship between meals and dyspepsia symptoms helps to analyze the pathophysiological basis of dyspepsia, i.e., whether it is an acid-related disease or a power-related dyspepsia. Food buffers gastric acid and raises gastric pH, thus reducing the symptoms caused by acid irritation. If a patient has epigastric discomfort, pain, or distention on an empty stomach that is relieved after a meal, it is likely to be an acid-related disorder. If a patient has symptoms such as epigastric discomfort, pain, and early saturation of epigastric distension after a meal, but no symptoms on an empty stomach, or symptoms also on an empty stomach that worsen after a meal, attention should be paid to the presence of excessive or inappropriate food that increases the gastric digestive load or conditions that are not consistent with gastric digestive physiology. If there is no food factor, the above symptoms can be regarded as gastric dysfunction-related dyspepsia, and its etiology may be organic disease or FD. For the above situation, it is recommended to choose antacid or acid suppressant to treat acid-related disease, and choose pro-dynamic agent to treat gastric dysfunction-related dyspepsia, and take the drug for 2 weeks, if the symptoms are reduced or disappeared, the above judgment is further supported; if it is ineffective, further examination is recommended If not, further examination is recommended. After more than 2 years of discussion and consultation, we now propose a diagnosis and treatment process for dyspepsia in China, taking into account the international diagnosis and treatment process for dyspepsia, the common gastric diseases in China and the characteristics of the diagnosis and treatment of dyspepsia, and summarizing the above basis. The consultation and treatment flow is 2 times to raise the problem (diamond-shaped mark) in order to select further treatment options, i.e., further examination is needed or empirical treatment is selected according to the relationship between symptoms and meal intake. In cases where empirical treatment is effective, it can be judged as acid-related disease or dysmotility-related dyspepsia (long box marker). In cases where empirical treatment is ineffective, further investigations, including biochemical tests, ultrasound and gastroscopy, should be performed and treated accordingly according to the findings. If the relevant tests show negative results or positive results that do not explain their symptoms, further tests should be performed if necessary, including gastric electrograms, gastric emptying tests, etc., to understand the gastric power function, the use of visceral perception tests to understand whether there are abnormalities in perception, and psychological tests if necessary. At present, the development of endoscopy is quite common in our country, and the cost is relatively low. Combining with our patients’ access system, endoscopy is proposed as the main means to diagnose dyspepsia.