Alarm symptoms for dyspepsia, such as anemia, evidence of gastrointestinal bleeding, weight loss, dysphagia, odynophagia and new onset at age > 50 years are associated with an increase risk of cancer. Most guidelines for the management of dyspepsia emphasize that patients with alarm symptoms should undergo aggressive evaluation including endoscopy.We reported a case of 65 years old female with several alarm symptoms that suggesting of malignancy, but endoscopy finding revealed gastroduodenitis erosive NSAID due to the pain killer herbal medicine use.