When should I refer a patient with gastritis for gastroenterology asse

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

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 ,.
Symptoms do not adequately respond to antacids, alginates, or other treatments given in primary care, indicating non-responsive or unexplained gastro-oesophageal symptoms ,.
There is doubt about the diagnosis after initial assessment in primary care, or if the patient is unable to eat sufficiently .
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 ,.

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

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