Alarm features in dyspepsia requiring endoscopy

What it is

Whether dyspepsia needs endoscopy turns on a short list of alarm features: anemia, dysphagia, persistent vomiting and weight loss. Odynophagia belongs with them, since dysphagia, odynophagia, and weight loss together are an indication for upper endoscopy to rule out cancer. Age is read alongside them. The same list applies to reflux: in a patient without alarm features, symptom relief with PPI therapy confirms the diagnosis of GERD, and no test is needed to reach it. Reflux that does not answer treatment is an indication on its own: GERD symptoms refractory to empiric therapy with PPIs call for upper endoscopy, and if that endoscopy is normal, then choose ambulatory esophageal pH monitoring or impedance pH testing while taking a PPI for symptom-reflux correlation.