When should I refer a patient with gastritis for gastroenterology assessment?

Refer a patient with gastritis for gastroenterology assessment if:

• They have alarm features suggestive of malignancy or significant acute gastrointestinal bleeding, requiring urgent referral to a specialist ¹,⁵.
• Symptoms do not adequately respond to antacids, alginates, or other treatments given in primary care, indicating non-responsive or unexplained gastro-oesophageal symptoms ¹,⁵.
• There is doubt about the diagnosis after initial assessment in primary care, or if the patient is unable to eat sufficiently ¹.
• They have Helicobacter pylori infection that has not responded to second-line eradication therapy, or if there are limited antibiotic options for eradication therapy, necessitating specialist advice ²,⁵.

Routine early endoscopy is not recommended unless these criteria are met, as it does not improve patient outcomes and carries procedural risks ².