Chronic or recurrent upper abdominal pain or discomfort, referred to as dyspepsia, occurs in 20% to 30% of people in the community. In more than 50% of patients who see a physician for dyspepsia, the diagnostic work-up fails to find a definite cause, such as peptic ulcer disease. Nonulcer dyspepsia is costly and affects quality of life. Its pathogenesis remains unknown, and its treatment remains unsatisfactory. Among the factors that may play a role in the development of symptoms in nonulcer dyspepsia, Helicobacter pylori infection, upper gastrointestinal tract dysmotility, and mechanosensory dysfunction received the most attention in the past year. New management guidelines from the American Gastroenterological Association advocate noninvasive testing and treatment for H. pylori rather than endoscopy for young dyspeptic patients without alarm features.