Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute upper gastrointestinal (GI) tract bleeding
  • oesophageal obstruction by foreign body or food bolus
  • severe vomiting with dehydration

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network


Stable reflux disease controlled with proton pump inhibitor (PPI) – if symptoms recur on cessation of therapy, recommence at the lowest dose which controls them.

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • relevant upper gastrointestinal (GI) symptoms with any red flags:
    • overt GI bleeding
    • weight loss ≥ 10% in previous 3 to 6 months
    • dysphagia which does not fully resolve with 2 weeks PPI therapy
    • persistent vomiting
    • iron deficiency
  • suspected oesophageal or gastric cancer on imaging

Category 2 — appointment clinically indicated within 90 days

  • volume regurgitation with suspected aspiration/history of aspiration pneumonia

Category 3 — appointment clinically indicated within 365 days

  • previous diagnosis of Barrett’s oesophagus for consideration of surveillance
  • consideration of anti-reflux surgery
  • - symptoms are not relieved by double dose PPI and may require physiologic function testing to clarify the cause of symptoms (pH and/or manometry/impedance)
  • request a single “one off” upper GI endoscopy in person/s with relevant upper GI symptoms > 50 years of age to exclude Barrett’s and allay concerns – there is no evidence that this improves symptom control or prolongs survival

For information on referral forms and how to import them, please view general referral information.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements


  • description of symptoms - location, character, radiation, time course, pattern (duration from initial onset, and frequency of episodes), precipitating or relieving factors (food, exertion, antacids, proton pump inhibitor (PPI))
  • presence or absence of red flags:
    • persistent or progressive dysphagia (solids/liquids)
    • odynophagia
    • weight loss
    • nocturnal cough or choking
    • haematemesis
    • anaemia
  • medical management to date including response to twice daily PPI
  • past medical history including documented Barrett’s oesophagus
  • family history
  • current and previous prescription medications including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), novel oral anticoagulants and warfarin
  • volume regurgitation with suspected aspiration/history of aspiration pneumonia
  • smoking and alcohol
  • stress and any issues with anxiety
  • allergies


  • examination findings e.g. epigastric mass or lymph nodes
  • body mass index (BMI)


  • complete blood examination (CBE)
  • urea, electrolytes, and creatinine (UEC)
  • iron studies if haemoglobin (Hb) or mean corpuscular volume (MCV) are low
  • helicobacter pylori status – serology, faecal antigen or breath test
  • previous endoscopic findings with histology, if performed
  • barium contrast swallow (dysphagia)
  • abdominal computed tomography (weight loss)
  • ultrasound (suspected biliary colic)
  • oesophageal manometry/pH monitoring, if performed

Clinical management advice

Most people with typical reflux or indigestion/dyspepsia symptoms can be safely managed in the community. This is especially true for people with long standing symptoms in the absence of red flags.

Most upper gastrointestinal (GI) symptoms are functional in nature and respond well to reassurance, after a structured history and clinical examination with limited basic investigations.

It is always worth considering the possibility of pregnancy as a cause for symptoms

Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician to discuss your concerns.

If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.

Clinical resources

Consumer resources