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Referral criteria

This is a summary of the referral criteria for upper GI endoscopy outlined in NICE clinical guidelines.


Immediate referral

Significant acute GI bleeding.


Urgent referral (within 2 weeks)

1. Patients of any age with dyspepsia who present with any of the following should have an urgent referral for endoscopy or referral to a specialist in upper gastrointestinal cancer:

  • chronic gastrointestinal bleeding
  • progressive dysphagia
  • progressive unintentional weight loss
  • persistent vomiting
  • iron deficiency anaemia
  • epigastric mass
  • suspicious barium meal result.

2. Patients aged 55 years and older with unexplained and persistent recent-onset dyspepsia.

3. Patients presenting with the following, even in the absence of dyspepsia, should have an urgent referral for endoscopy or referral to a specialist in upper gastrointestinal cancer:

  • dysphagia
  • unexplained upper abdominal pain and weight loss, with or without back pain
  • upper abdominal mass
  • obstructive jaundice (depending on clinical state).

and consider urgent referral for:

  • persistent vomiting and weight loss in the absence of dyspepsia
  • unexplained weight loss
  • iron deficiency anaemia.

4. Consider urgent referral for patients with unexplained worsening of their dyspepsia who are known to have any of the following risk factors:

  • Barrett's oesophagus
  • dysplasia
  • atrophic gastritis (pernicious anaemia)
  • intestinal metaplasia
  • peptic ulcer surgery more than 20 years ago.

See the NICE clinical guideline CG27 on referral for suspected cancer and the NICE clinical guideline CG17 on dyspepsia.


Non-urgent referral

British Society of Gastroenterology recommendations and expert advice suggest non-urgent referral for:

  • patients with liver disease, to detect oesophageal varices
  • patients who have resistant H.pylori infection with worsening of dyspepsia
  • post-treatment (6 to 8 weeks) endoscopy for gastric ulcer and bleeding duodenal ulcer
  • coeliac disease, for confirmatory biopsy
  • Barrett's oesophagus surveillance
  • follow-up of oesophageal ulcer (8 weeks).

(See reference documents at BSG website - Guidelines for the diagnosis and management of Barrett´s columnar-lined oesophagus and Guidelines for the management of patients with coeliac disease.

This page was last updated: 22 November 2007

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.