Table 1. Referral indications divided in 4 groups, of which the first three groups are considered appropriate referral indications and the last group is considered inappropriate according to the NHG guideline.

Referral indications
Alarm symptoms	Follow-up	Other referral indications according to the guideline	Referral indications not mentioned in the guideline
Dysphagia	Follow-up of gastric ulcer healing	Persistent or recurrent dyspepsia older than age 50 with a negative H. pylori status	Dyspepsia younger than age 50 without alarm symptoms
Unexplained weight loss		First-degree relative older than age 40 of a patient with familial gastric cancer	Persistent or recurrent dyspepsia older than age 50 with unknown H. pylori status
Gastrointestinal bleeding			Familial esophageal cancer
Anemia			Reassurance
Persistent vomiting