What are the key indications for referring a patient for an OGD in the context of upper GI symptoms?

Key indications for referring a patient for oesophagogastroduodenoscopy (OGD) in the context of upper gastrointestinal symptoms include:

• Age and symptom persistence: Adults aged 55 and over with treatment-resistant dyspepsia or dyspepsia accompanied by weight loss, raised platelet count, nausea, or vomiting should be considered for non-urgent direct access OGD or urgent referral via a suspected cancer pathway if weight loss is present ¹,³.
• Alarm symptoms: Presence of dysphagia, significant acute gastrointestinal bleeding, or haematemesis warrants urgent specialist referral and OGD to exclude malignancy or serious pathology ¹,²,³.
• Unexplained or non-responsive gastro-oesophageal symptoms: Patients of any age with symptoms suggestive of gastro-oesophageal reflux disease (GORD) that do not respond to treatment or remain unexplained after initial primary care assessment should be referred for specialist evaluation and consideration of OGD ¹.
• Surveillance indications: Patients with Barrett's oesophagus confirmed by endoscopy and histopathology may require surveillance OGD depending on dysplasia presence, risk factors, and patient preference ¹.
• Medication review and exclusion of other causes: Before referral, review medications that may cause dyspepsia (e.g., NSAIDs, calcium antagonists) and consider suspending NSAIDs if referral is needed ¹.
• In children and young people: Red flag symptoms such as frequent projectile vomiting, bile-stained vomit, haematemesis, blood in stool, abdominal tenderness or mass, and systemic signs like fever or altered responsiveness require specialist referral and may prompt OGD ².

These indications align with the consensus from UK guidelines and are supported by expert recommendations from the Joint Committee of the Royal Colleges and British Society of Gastroenterology, which emphasize OGD for persistent, unexplained upper GI symptoms, alarm features, and cancer suspicion (Axon et al., 1995).