Patients presenting with indigestion symptoms with any of the following should be referred:1,19

·       prolonged/recurrent indigestion

·       moderate/severe pain

·       aged 55+

·       unintended weight loss

·       swallowing difficulties (dysphagia)

·       repeated vomiting

·       iron deficiency anaemia

·       sensation of 'a lump' in the stomach

·       prolonged NSAIDs use

·       faintness

·       night sweats

Urgent referral is needed if the pain is severe and persistent, has been going on for more than couple of weeks, is worsening or there is unexplained pain in the upper abdomen. Similarly, if the pain is occurring with other symptoms, such as chest pain or pain radiating through the back to the arms, breathlessness, sweating, nausea and vomiting, referral is urgent.

Bloody vomit or bloody/darkened faeces can also indicate an urgent referral, but beware that iron tablets and foods such as beetroot can darken the stool,

Pregnant or breastfeeding women may want to consult with their GP, for example if symptoms are ongoing or worsening, but NHS Choices gives advice about self care approaches for indigestion and heartburn.20