Background: Dyspepsia is a common clinical problem. More patients with dyspepsia have no detectable lesion. Organic causes of dyspepsia only detected by endoscopy if suspected by age or alarm features. Aim of Study: To evaluate the prevalence of significant endoscopic findings and use alarm features and the age in outpatients with dyspepsia in predicting the presence of Significant Endoscopic Findings (SEFS). Patients and Methods: This is cross-sectional observational study was carried out in Tanta University Hospitals Internal Medicine Department on one hundred Egyptian outpatients with dyspepsia in the period from July 2017 to January 2018. All patients enrolled in this study were subjected to upper gastro intestinal endoscopy, and histopathological examination to suspected cases only. Results: Our study showed that the prevalence of SEFS in dyspepsia patients was 25%, mostly found in patients who were old age and or had alarm features. The most common endoscopic abnormality was non erosive gastritis (73.2% n 37), followed by small HH (70.9% n 35), class A esophagitis represent (16.8% n 8), gastric ulcer disease was found in (17% n 11), Malignancy was found in only (6.4% n 3), erosive esophagitis was found in (6.4% n 3), sever gastritis was found in (12.8% n 6) and sever doudonitis in (4.3% n 2). Conclusion: The study showed the low prevalence of SEFs, and no need for endoscopy in young patients with no alarm features and they can be managed by non-endoscopic approach. However, it is highly recommended in all patients represented with alarming symptoms.