When Should You Get a Gastroscopy?

When Should You Get a Gastroscopy? Age, Symptoms and Family History Explained

Most people know roughly when they are supposed to have a colonoscopy. Almost nobody knows when they are supposed to have a gastroscopy.

That is not because the test matters less. Upper endoscopy is the only examination that sees the stomach lining directly, and it is the only way to find gastric cancer early enough for it to be curable. The difference is that colorectal cancer screening is organised by age almost everywhere, while stomach cancer screening is organised by risk — and in most Western countries it is not organised at all.

So the honest answer to “at what age should I have a gastroscopy?” is that age alone is the wrong question. International guidelines point to three things instead: your symptoms, your family history, and where you grew up.

1. Symptoms: when endoscopy should not wait

The clearest criteria come from UK NICE guidance, which separates urgent from non-urgent referral.^[1]

Urgent endoscopy (within two weeks) is recommended for:

• Dysphagia — difficulty swallowing — at any age. There is no age threshold on this one.
• Age 55 or over with weight loss, combined with upper abdominal pain, reflux or dyspepsia.
• An upper abdominal mass consistent with stomach cancer.

Non-urgent endoscopy should be considered for:

• Haematemesis (vomiting blood) at any age.
• Age 55 or over with treatment-resistant dyspepsia, or upper abdominal pain with low haemoglobin, or nausea and vomiting alongside weight loss, reflux or dyspepsia.

One further criterion is easy to miss because it has nothing to do with digestion. British Society of Gastroenterology guidelines state that in men and postmenopausal women with newly diagnosed iron-deficiency anaemia, gastroscopy and colonoscopy “should generally be the first-line GI investigations” — a strong recommendation, even when the person has no stomach symptoms at all.^[2] Unexplained iron deficiency is a reason for endoscopy in its own right.

If you are under 50, have no alarm symptoms and no particular risk factors, guidelines generally recommend starting with a non-invasive H. pylori test rather than going straight to endoscopy.^[3]

2. Family history: the clearest rule there is

If a parent, sibling or child has had stomach cancer, two major guideline bodies now agree on what to do — and they agree on the same age.

The 2025 European MAPS III guideline recommends endoscopic screening for first-degree relatives of gastric cancer patients at age 45, or 10 years before the age at which the affected relative was diagnosed, whichever comes first.^[4] The Maastricht VI/Florence consensus reaches the same threshold: endoscopy with biopsies in asymptomatic people with a family history of gastric cancer “at age 45 and above."^[3]

There is also a step that comes decades earlier and is far simpler. MAPS III recommends non-invasive H. pylori screening and eradication between the ages of 20 and 30 for first-degree relatives of gastric cancer patients.^[4] This is a breath or stool test and, if positive, a short course of antibiotics — and the evidence is that eradication “offers the chance for gastric cancer prevention at any age in adulthood,” with the benefit greatest before severe atrophic changes have developed.^[3]

If your family history suggests an inherited syndrome — several affected relatives, diffuse-type gastric cancer, or a diagnosis at a young age — that is a separate pathway requiring genetic counselling rather than routine screening.^[5]

3. Where you grew up matters more than most people expect

Stomach cancer is one of the most geographically unequal cancers there is. Asia accounts for roughly 71% of all cases worldwide, with Eastern Asia carrying by far the highest rates, followed by Eastern Europe and South America.^[6]

This is why countries respond so differently. Korea’s National Cancer Screening Program offers biennial screening to all adults aged 40 and over, with endoscopy as the primary modality since 2018. Participation rose from 7.4% in 2002 to 63.8% in 2022, and endoscopy detects cancer at roughly eight times the rate of the older barium studies it replaced.^[7] Japan runs a comparable programme. Most of Western Europe and North America run none at all, because population-wide screening is not cost-effective where incidence is low.

The consequence is that an individual’s risk can travel with them. The 2024 AGA Clinical Practice Update recommends that first-generation immigrants from high-incidence regions be considered for screening endoscopy in the United States, alongside people with a first-degree relative with gastric cancer and those with hereditary cancer syndromes.^[8]

Consider discussing gastroscopy with your doctor if you:

• Grew up in East Asia, Eastern Europe, Central or South America
• Have a first-degree relative with stomach cancer
• Have had H. pylori infection, particularly if eradication was never confirmed
• Have previously been diagnosed with atrophic gastritis, intestinal metaplasia or gastric polyps
• Have had previous gastric surgery
• Smoke, or have a long history of smoking

4. If you already have a precancerous diagnosis

For people already diagnosed with atrophic gastritis or gastric intestinal metaplasia, the interval depends on how extensive the changes are.

MAPS III recommends high-quality endoscopy every three years for extensive endoscopic changes or advanced histological stages of atrophic gastritis. Where advanced changes are combined with a first-degree relative with gastric cancer, the guideline suggests more intensive follow-up — every one to two years. Conversely, mild-to-moderate changes restricted to the antrum, with no other risk factors, generally require no surveillance endoscopy at all.^[4] The AGA update reaches a similar three-year interval for extensive intestinal metaplasia.^[8]

This is worth knowing, because “you have gastritis, come back sometime” is not a surveillance plan. The staging of the changes determines the interval.

5. Not all gastroscopies are equal

If you are having the test because of genuine risk, how it is performed matters as much as whether it is performed.

ESGE performance measures set concrete minimum standards for a diagnostic upper endoscopy: at least seven minutes from intubation to extubation for a first diagnostic gastroscopy, photodocumentation of at least ten anatomical landmarks in 90% of reports, and — for gastric precancerous conditions — at least two biopsies from the antrum and two from the corpus.^[9] MAPS III adds that these biopsies should be guided by virtual chromoendoscopy and submitted in two separately labelled vials, so the pathologist can stage the changes rather than simply describe them.^[4]

The AGA makes the same point in different words: quality screening requires high-definition white-light endoscopy with image enhancement, mucosal cleansing, adequate insufflation, sufficient inspection time and a systematic biopsy protocol.^[8]

A three-minute look with no biopsies is a procedure. It is not a screening examination.

What to expect

A diagnostic gastroscopy takes roughly 10–15 minutes and is usually performed under sedation. You fast beforehand, and most people go home the same day. Biopsies are painless. Results from the endoscopist are usually immediate; pathology takes several days.

At BB Global Health, gastroscopy forms part of our oncologic check-up pathway at JCI-accredited hospitals in Istanbul, performed with high-definition and image-enhanced systems and the systematic biopsy protocols described above. If you have a family history of stomach cancer, an unresolved H. pylori infection, or a previous diagnosis of gastritis that was never followed up, our medical coordination team can arrange an assessment and advise on the appropriate interval for your risk profile.

The test itself is short. The decision to have it is what changes the outcome.

References

1. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12) — oesophageal and stomach cancer. https://www.nice.org.uk/guidance/ng12
2. Snook J, Bhala N, Beales ILP, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030–2051. doi:10.1136/gutjnl-2021-325210
3. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–1762. doi:10.1136/gutjnl-2022-327745
4. Dinis-Ribeiro M, Libânio D, Uchima H, et al. Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): ESGE, EHMSG and ESP Guideline update 2025. Endoscopy. 2025;57(5):504–554. doi:10.1055/a-2529-5025
5. Blair VR, McLeod M, Carneiro F, et al. Hereditary diffuse gastric cancer: updated clinical practice guidelines. Lancet Oncol. 2020;21(8):e386–e397. doi:10.1016/S1470-2045(20)30219-9
6. World Health Organization / International Agency for Research on Cancer. Stomach — Global Cancer Observatory fact sheet (GLOBOCAN 2024). https://gco.iarc.who.int/media/globocan/factsheets/cancers/7-stomach-fact-sheet.pdf
7. Lee K, Suh M, Choi KS. Current Status of the National Cancer Screening Program in Korea: History, Achievements, and Future Directions. J Prev Med Public Health. 2025;58(4):337–347. doi:10.3961/jpmph.25.268
8. Shah SC, Wang AY, Wallace MB, Hwang JH. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Gastroenterology. Published online 23 December 2024. doi:10.1053/j.gastro.2024.11.001
9. Bisschops R, Areia M, Coron E, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2016;48:843–864.

This article is for general information and does not replace individual medical advice. Screening recommendations differ between countries and must be applied to your individual risk profile by a qualified physician. All clinical figures cited are referenced above and reviewed annually.