Background and Objectives Dyspepsia is the commonest indication for upper gastrointestinal (UGI) endoscopy. This study was done to describe the UGI endoscopic findings and the risk factors like alcohol abuse, smoking, pan chewing, and drug intake and the endoscopic findings in patients with alarm symptoms. Materials and Methods This was an institution-based (Department of General Surgery at Government T.D. Medical College, Alappuzha) observational study (descriptive) on 250 dyspeptic patients who underwent UGI endoscopy for the duration of 1 year between November 2018 and October 2019. Results Among the patients, 130 were males and 120 were females. The mean age was 51.36 years. The majority were between 36 and 65 years (65.6%) of age. Precisely, 28.8% showed alarm symptoms. The commonest alarm symptoms were vomiting (26.8%), weight loss (7.6%), and gastrointestinal bleed (6.4%). Also, 237 (94.8%) patients had abnormal findings. The commonest abnormal findings included gastric erosions/erythema in 197 (78.8%), duodenal erosions/erythema in 69 (27.6%), and esophageal erosions/erythema in 56 (22.4%) patients. Substance use included smoking (29.6%), followed by alcoholism (27.2%) and pan chewing (14%). Dyspepsia along with alarm symptoms was seen in patients with malignant endoscopic findings. The commonest malignancy was stomach cancer (4.8%). Conclusion Dyspepsia was more common among males aged 36 to 65 years. Gastric, duodenal, and esophageal erosions/erythema were the commonest abnormal findings. Smoking and alcoholism were common in patients with dyspepsia. Malignant endoscopic findings were common in patients with alarm symptoms. UGI endoscopy is an effective and appropriate initial investigation to assess patients with dyspepsia.