Objective To improve the capability identifying the causes of dyspepsia. Methods Standardized questionnaires were used to investigate the 2623 dyspeptic outpatients among four hospitals in Guan-zhong area, Shaanxi Province. All of the patients were followed up for 4-24 weeks, and finally diagnosed according to consistent criteria. Results The frequency rate of functional dyspepsia (FD) was 50.5%, benign organic causes were present in 39.3% and malignant diseases accounted for the remaining 10.2%. In the patients who had marked alarm symptoms, the proportion of benign organic causes and malignant diseases rose to 48.3% and 29.8% respectively, significantly higher than that without alarm symptoms (33.9% and 2.7% respectively)(P