The significance of gastroscopy in the investigation of upper abdominal complaints has diminished as the occurrence of recurrent peptic ulcers caused by Helicobacter pylori infection as well as the incidence of gastric cancer have decreased. The investigation is unpleasant for the patient and its indication should thus be carefully and individually considered. Before referring the patient to gastroscopy, find out about the histological findings of the previous gastroscopies. If the histology of the stomach and of the descending duodenum have been normal, Helicobacter pylori infection, peptic ulcer, gastric cancer and coeliac disease are improbable. Gastroscopy is indicated if the patient has alarming symptoms or history, as well as in most patients with dyspepsia who are over 55 years of age.