BACKGROUND　No　studies　have　evaluated　the　predictive　value　of　alarm　symptoms　for　organic　dyspepsia　and　organic　upper　gastrointestinal　(GI)　diseases　based　on　Rome　IV　criteria　in　the　Chinese　population.　AIM　To　evaluate　the　predictive　value　of　alarm　symptoms　for　dyspeptic　patients　based　on　Rome　IV　criteria.　METHODS　We　performed　a　cross-sectional　study　of　dyspepsia　patients　who　met　the　inclusion　and　exclusion　criteria　at　two　academic　urban　tertiary-care　centers　from　March　2018　to　January　2019.　Basic　demographic　data,　dyspeptic　information,　alarm　symptoms,　lifestyle,　examination　results,　family　history　and　outpatient　cost　information　were　collected.　Dyspepsia　patients　with　normal　findings　on　upper　GI　endoscopy,　epigastric　ultrasound　and　laboratory　examination　and　withoutHelicobacter　pylori-associated　dyspepsia　were　classified　as　functional　dyspepsia.　RESULTS　A　total　of　381　patients　were　enrolled　in　the　study,　including　266　functional　dyspepsia　patients　and　115　organic　dyspepsia　patients.　There　were　24　patients　with　organic　upper　GI　disease　among　patients　with　organic　dyspepsia.　We　found　that　based　on　the　Rome　IV　criteria,　alarm　symptoms　were　of　limited　value　in　differentiating　organic　dyspepsia　and　organic　upper　GI　diseases　from　functional　dyspepsia.　Age　(odds　ratio　(OR)　=　1.056,P=　0.012),　smoking　(OR　=　4.714,P=　0.006)　and　anemia　(OR　=　88.270,P＜　0.001)　were　independent　predictors　for　organic　upper　GI　diseases.　For　the　comparison　of　epigastric　pain　syndrome,　postprandial　distress　syndrome　and　epigastric　pain　syndrome　combined　with　postprandial　distress　syndrome,　the　results　showed　that　there　were　statistically　significant　differences　in　anorexia　(P=　0.021)　and　previous　visits　(P=　0.012).　The　ClinicalTrials.gov　number　is　NCT　03479528.　CONCLUSION　Most　alarm　symptoms　had　poor　predictive　value　for　organic　dyspepsia　and　organic　upper　GI　diseases　based　on　Rome　IV　criteria.　Gastroscopic　screening　should　not　be　based　solely　on　alarm　symptoms.