Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CG184,NICE NG12.
- Alarm symptoms: Presence of dysphagia, significant acute gastrointestinal bleeding, or haematemesis warrants urgent specialist referral and OGD to exclude malignancy or serious pathology NICE CG184,NICE NG1,NICE NG12.
- 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 NICE CG184.
- 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 NICE CG184.
- 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 NICE CG184.
- 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 NICE NG1.
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.
Key References
- CG184 - Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
- NG1 - Gastro-oesophageal reflux disease in children and young people: diagnosis and management
- NG12 - Suspected cancer: recognition and referral
- (Axon et al., 1995): Guidelines on appropriate indications for upper gastrointestinal endoscopy. Working Party of the Joint Committee of the Royal College of Physicians of London, Royal College of Surgeons of England, Royal College of Anaesthetists, Association of Surgeons, the British Society of Gastroenterology, and the Thoracic Society of Great Britain.