Considerations in the revised Dutch College of General Practitioners' (NHG) practice guideline 'Gastric Symptoms': The NHG practice guideline 'Gastric symptoms' differs slightly from guidelines in other countries. In other parts of Europe and in Asia the guidelines advise performing a Helicobacter pylori test immediately on all patients with gastric symptoms. In the Netherlands, patients experiencing symptoms for the first time are initially prescribed antacids in accordance with a 'step-up' policy. This commentary describes the arguments for giving priority to an H. pylori test.