Around 25-40% of adults have chronic and recurrent dyspeptic symptoms Most patients have no structural lesions and malignancy is rare, especially in Western populations Two empirical strategies show results—a non-invasive test for H pylori and treatment of H pylori positive patients with eradication therapy (test and treat), and empirical treatment with proton pump inhibitors The 13C-urea breath test and stool antigen test are the recommended non-invasive tests for H pylori infection. Patients should stop proton pump inhibitors two weeks before and antibiotics four weeks before performing either of these tests