It must be more of the expense of the tests, since there is NO way to cheat on the TST. The powder they coat you in changes color based upon sweating and therefore there is no input from the patient...just a visual confirmation of the sweating (or lack of sweating). They are both very expensive pieces of equipment, but certainly these are available in the UK somewhere. It would be good in your case to document where ever you can, since many of your tests are negative. BTW, the skin biopsy also checks for autonomic fiber damage, so yet another good reason to have this done.

I do agree that you would likely benefit from a GI scope to rule out or confirm hiatal hernia, and/or any other obvious problem. Then if negative or what they find doesn't fit for the symptoms you are experiencing, then the empty test can be considered. But the hiatal hernia would certainly explain the upper gnawing discomfort you have.

So easy for the doctors to stick you with a general 'indigestion' label instead of looking forward. I would also agree that if this is an on-going problem, that it's NOT just indigestion/dyspepsia.