Background: Chronic dyspepsia is one of the most common gastrointestinal complaints encountered in clinical practice. Upper gastrointestinal (GI) endoscopy is the gold standard investigation for identifying structural lesions responsible for persistent dyspeptic symptoms and excluding serious pathology such as peptic ulcer disease or upper GI malignancy.Objective: To evaluate upper gastrointestinal endoscopic findings in patients presenting with chronic dyspepsia and determine the prevalence of significant gastrointestinal lesions.Methods: A retrospective observational study was conducted among 300 adult patients with chronic dyspepsia who underwent upper GI endoscopy at a tertiary care hospital between January and December 2025. Demographic characteristics, clinical symptoms, endoscopic findings, and biopsy results (where indicated) were analyzed.Results: The mean age of participants was 45.8 ± 13.6 years, with males accounting for 56.3% of cases. The most frequent endoscopic findings were gastritis (38.3%), normal endoscopy (24.0%), gastroesophageal reflux disease (GERD) (15.0%), duodenitis (8.7%), peptic ulcer disease (7.7%), and gastric polyps (2.3%). Gastric malignancy was identified in 1.7% of patients. Alarm symptoms and age above 50 years were significantly associated with abnormal endoscopic findings (p<0.05).Conclusion: Gastritis remains the most common endoscopic finding among patients with chronic dyspepsia. Upper GI endoscopy plays an important role in detecting clinically significant lesions, especially in older patients and those presenting with alarm symptoms.