When to Refer to a Gastroenterologist

Presence of alarm symptoms: dysphagia, weight loss, persistent vomiting Iron deficiency anemia Abnormal abdominal examination Continued symptoms despite empiric therapy Helicobacter pylori infection persists (by breath test) despite 2 courses of antibiotics Acute GI bleeding (hematemesis or melena) Gastric ulcers (to confirm healing by endoscopy) Refractory ulcers