Objective. To investigate the effects of chiropractic management of patients with symptoms of idiopathic dyspepsia. Design. Prospective, sequential, longitudinal pilot cohort study using a structured questionnaire to determine pre- and post-treatment outcomes. Setting. Private chiropractic clinic in south-west England. Subjects. Eighty-three consecutive patients presenting to the clinic who confirmed the presence of pain of digestive origin in the central chest or epigastric area of greater than 2 years duration. Intervention. Chiropractic spinal manipulative therapy and adjunctive soft tissue modalities. Results. Patients showed an improvement in the severity (Pandlt;0.001) and frequency of their symptoms (Pandlt;0.001) without any reported adverse events. Thirty-seven of 83 patients were able to downgrade their medication (Pandlt;0.001) suggesting a possible saving in healthcare costs. Conclusion. Patients with chronic idiopatic dyspepsia may benefit from conservative chiropractic management in terms of decreased symptom frequency and severity over a 3-month period and dependence on palliative pharmacological interventions. The pilot study offers scope for a larger controlled trial to investigate efficacy.