What criteria should I use to decide when to refer a patient with dyspepsia for endoscopy?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Refer a patient with dyspepsia for endoscopy if they present with dyspepsia together with significant alarm features suggestive of malignancy, such as weight loss, low haemoglobin levels, raised platelet count, or persistent nausea or vomiting, especially in patients aged 55 and over, and refer immediately (on the same day) to a specialist .

Additionally, consider non-urgent, direct access upper gastrointestinal endoscopy for people aged 55 and over with treatment-resistant dyspepsia or dyspepsia accompanied by weight loss .

In cases where there is suspicion of oesophageal or stomach cancer, such as dyspepsia with weight loss in patients aged 55 and over, referral using a suspected cancer pathway is recommended .

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