Can the indications for gastroscopy in dyspeptic patients be tightened?

OBJECTIVE: Gastroscopy is frequently performed to investigate upper gastrointestinal (GI) symptoms. This analysis aimed to identify upper GI symptoms associated with clinically significant pathology, low-yield gastroscopies and opportunities to refine future referral guidelines. METHODS: This retrospective study analysed symptomatic gastroscopies performed at two public hospitals between 15 January 2024 and 31 October 2024, using data from a patient registry. The association of patient age, sex and symptoms with clinically significant pathology was examined using a binary logistic regression model. RESULTS: dyspepsia). In patients aged <50 years, significant pathology was identified in 6.7% of those with vomiting and 3.3% of those with reflux. CONCLUSIONS: Weight loss, dysphagia and anaemia should continue to trigger investigation in all patients. Reflux and vomiting were considered low-yield symptoms in patients aged <50 years, indicating opportunities for more efficient allocation of resources. Further prospective follow-up studies are needed to assess the role of gastroscopy in patients aged 55-60 years with dyspepsia and in patients aged <50 years with reflux or vomiting.