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Patients and trial participants should be aware of the following red flag symptoms that require urgent review: Dysphagia (difficulty swallowing) or odynophagia (painful swallowing) Unexplained weight loss beyond that expected from the medication Persistent vomiting or an inability to keep fluids down Haematemesis (vomiting blood) or melaena (black, tarry stools) Severe or worsening chest pain if you experience severe chest pain, particularly with breathlessness, sweating, or pain radiating to the arm or jaw, call 999 immediately , as these may indicate a cardiac emergency rather than a digestive cause Symptoms that persist despite appropriate self-management , or that significantly affect daily life These symptoms may indicate more serious conditions such as oesophagitis, peptic ulceration, or, in rare cases, upper GI pathology requiring endoscopic investigation