Background and Objectives: Dyspepsia is a common condition that clinicians encounter in their practice and it has a great impact on the patients quality of life. The incidence of upper gastrointestinal tract malignancy in patients with dyspepsia and their predictability based on history is unknown. This study helps to evaluate the incidence of upper GIT malignancy, different endoscopic presentation of dyspepsia, to reduce unwanted prescriptions, and to study importance of upper GI endoscopy. Methodology: Study includes 140 dyspeptic patients attending the OPD and admitted to all the units in Department of General Surgery in SSIMS & RC, Davangere with the complaints of upper abdominal pain/discomfort, nausea, vomiting, bloating/fullness of upper abdomen and were evaluated by detailed history & clinical examination followed by upper GI Endoscopy after getting written consent from patients. Biopsy were taken for HPE if any suspicious lesion of malignancy is present. This study conducted over period of two years. Results: A total of 140 patients 84 are males and 56 are females. Maximum of these were in age groups between 25 to 55 years. Most common symptoms were epigastricpainac counting for 81.4%, followed by nausea/vomiting, heartburn, food intolerance, in digestion and weight loss. The endoscopy were normal in 72(51.4%) patients. The abnormal findings included gastritis accounting for 19.3%, gastritis with duodenitis (7.1%). hiatus hernia (4.3%), duodenal ulcer (3.6%) esophagitis (2.9%), Ca esophagus (2.9%), Ca stomach (2.1%) and gastric ulcer (1.4%) Incidence of malignancy is increased in patient with dyspepsia along with alarming symptoms. Conclusion: Dyspepsia with alarm symptoms increases risk of malignancy, whereas in dyspepsia without alarm symptoms there is reduced risk of malignancy. Incidence of upper GIT malignancy in dyspeptic patient with significant upper GIs copy findings is 5.7%.