Referral Guidelines for Patients with Gastritis

Age-Based Referral Thresholds

The European Society of Gastrointestinal Endoscopy recommends referral for all patients ≥45 years with severe dyspeptic symptoms for endoscopy, as the standardized incidence of gastric cancer rises significantly in this age group (19 per 100,000 for men, 9 per 100,000 for women) 3
The American Gastroenterological Association strongly recommends referral for patients ≥45 years with severe dyspeptic symptoms, as well as those with alarm symptoms such as anemia, unintentional weight loss, dysphagia, palpable abdominal mass, malabsorption, or persistent vomiting 1, 2
Urgent endoscopy is warranted for patients ≥55 years with dyspepsia and weight loss, or those >40 years from high-risk areas or with family history of gastro-esophageal cancer, according to the American College of Gastroenterology 1, 2

The National Institute for Health and Care Excellence recommends immediate referral if any of the following are present, regardless of patient age: anemia 3, unintentional weight loss (especially ≥5% in previous 6 months) 2, dysphagia 1, palpable abdominal mass 4, malabsorption 4, or persistent vomiting 2
The American College of Gastroenterology recommends urgent abdominal CT scanning for patients ≥60 years with abdominal pain and weight loss to exclude pancreatic cancer 1, 2

The European Society of Gastrointestinal Endoscopy recommends referral when symptoms are severe or refractory to first-line treatments (including H. pylori eradication if positive, proton pump inhibitors, or H2-receptor antagonists) 5
Referral is also appropriate when there is diagnostic doubt about whether the patient truly has functional dyspepsia versus organic pathology, or if the individual patient requests a specialist opinion 5

The American Gastroenterological Association recommends that all patients with known history of gastric ulcer should be referred and undergo repeat endoscopy with biopsy until healed, as malignancy may be present 3

The National Institute for Health and Care Excellence notes that local and national guidelines for colorectal and gastric cancer screening should always be followed, and the age cutoff for referral may need to be below 45 years depending on regional differences in gastric malignancy incidence 3, 5