Over a 2-year period, 34 children were referred to the division of pediatric gastroenterology at the University of Virginia with chronic upper gastrointestinal symptoms whose symptoms rapidly and completely resolved when their unrecognized constipation was treated. The average age at presentation was 8.24 (SD 0.78) years and average duration of upper intestinal symptoms was 15.6 (SD 3.5) months. Twenty-six of 34 had experienced recurrent vomiting, 6 complained of chronic nausea, 17 had chronic symptoms of gastroesophageal reflux, and 20 complained of chronic or recurrent abdominal pain, most often in the epigastric region. Smaller numbers had experienced early satiety, choking, gagging, dysphagia, or intermittent diarrhea. Given the prevalence of constipation in childhood, it seems likely that many children who experience chronic upper intestinal symptoms may be suffering from chronic unrecognized constipation as the cause of their upper intestinal symptoms.