Use of Upper Endoscopy Should Be Limited in GERD
(HealthDay News) – For patients with gastroesophageal reflux disease (GERD), use of upper endoscopy should be considered only in specific clinical situations, according to best practice advice issued by the American College of Physicians and published in the Dec. 4 issue of the Annals of Internal Medicine.
Nicolas J. Shaheen, MD, MPH, from the University of North Carolina School of Medicine in Chapel Hill, and colleagues sought to provide practice advice on use of upper endoscopy for GERD based on the best available evidence.
The authors note that upper endoscopy should only be used for select well-circumscribed clinical cases. Upper endoscopy is not required by patients with heartburn to establish GERD as the cause. Likewise, periodic upper endoscopy is not indicated for monitoring patients with GERD. However, it is indicated for heartburn that is associated with symptoms such as dysphagia, bleeding, anemia, weight loss, or recurrent vomiting. In cases of erosive esophagitis, healing should be monitored with upper endoscopy, and it also has a value in management of esophageal stricture secondary to GERD. For patients with GERD, the value of upper endoscopy in screening for esophageal adenocarcinoma is unclear, with use not recommended in women and patients ≤50 due to extremely low prevalence. Use in situations other than those described is likely to generate unnecessary costs and put patients at risk without improvement of clinical outcomes.
"Data suggest that upper endoscopy in the setting of GERD symptoms is useful only in a few, well-circumscribed situations, as previously reviewed," the authors write. "Avoidance of repetitive, low-yield endoscopy that has little effect on clinical management or health outcomes will improve patient care and reduce costs."