This paper considers the common presentation of upper gastrointestinal (GI) signs and symptoms. It discusses their prevalence, aetiology, clinical presentation and the importance of comprehensive history taking and examination. In addition, the article explores investigations, management pathways and criteria for referral to a gastroenterologist, including the two-week referral pathway. While the paper focuses on UK practice, it draws upon evidence and guidance from around the world and therefore guidelines for managing upper GI presentations can vary between countries and continents.