Dyspepsia remains one of mankind's most common afflictions. It affects virtually everybody at one time or another, it is responsible for the hundreds of millions of dollars spent each year on antacids and H2 antagonists, and it ranks second only to the common cold as a cause of loss of time from work. The condition denotes widely different things to different people, but by definition, complaints of dyspepsia must bear some relation to food or drink. (The term "dyspepsia" derives from dys, meaning "bad," and pepsis, meaning "digestion.") A physician writing in the Lancet more than a hundred years ago referred to dyspepsia as "the remorse of a guilty stomach." Unfortunately, the problem often turns out to be more serious than the transient pangs emanating from overindulgence. "Dyspepsy," De Quincey wrote in 1823, "is the ruin of most things: empires, expeditions, and everything else." That may be an overstatement. Still, dyspepsia can certainly be the harbinger of disastrous illness, as the following case illustrates.