Gastrointestinal causes of chest pain, including gastroesophageal conditions, gall bladder disease, and the ulcer and non ulcer dyspepsias account for perhaps 20%-30% of all such diagnoses. For diagnosing peptic ulcer and distinguishing it from the non-ulcer dyspepsias, the best imaging study remains the barium swallow combined with the upper GI series, preferably using the air contrast technique. Upper esophagogastroduodenal endoscopy (EGD) has been advocated in recent years, as it has been for studying esophageal reflux (see under gastroesophageal reflux), and is unfortunately becoming a replacement for standard upper GI barium studies. In the opinion of the program developers, the ONLY CLEAR INDICATION for EGD is the presence of ominous findings on the upper GI or for retrieving a foreign body. It should be stressed that EGD is 4 to 8 times more expensive than radiographic studies, and is so excruciatingly unpleasant that it is almost always performed with "conscious sedation," a euphemism for general anesthesia with loss of protective reflexes. The study, as mentioned under "esophageal disorders," is associated with a significant incidence of serious complications (cardiopulmonary collapse, bleeding, and perforation (1:1,500-2,000) and mortality (1:10,000-14,000)! The diagnosis of H. pylori infection does not require EGD since it can be made with the use of C-14-labeled urea (urease test) and newly available ELISA and other antibody tests.