Upper endoscopy guidelines for GERD

This month's issue of the Annals of Internal Medicine reviews best practice advice on upper endoscopy in GERD from clinical guidelines committee of the American College of Physicians.

Upper endoscopy is commonly used in the diagnosis and management of gastroesophageal reflux disease (GERD).

Evidence demonstrates that it is indicated only in certain situations, and inappropriate use generates unnecessary costs and exposes patients to harms without improving outcomes.

The Clinical Guidelines Committee of the American College of Physicians reviewed evidence regarding the indications for, and yield of, upper endoscopy in the setting of GERD.

Dr Nicholas Shaheen and colleagues highlighted how clinicians can increase the delivery of high-value health care.

The team report on best practice advice 1 that upper endoscopy is indicated in men and women with heartburn and alarm symptoms.

The team also examined best practice advice 2, where upper endoscopy is indicated in men and women with typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy.

Upper endoscopy is indicated in men and women with severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out Barrett esophagus.

Recurrent endoscopy after this follow-up examination is not indicated in the absence of Barrett esophagus.

In Barrett esophagus with no dysplasia, surveillance should occur at intervals of 3 to 5 years

Annals of Internal Medicine

The team report that upper endoscopy is also indicated in men and women with a history of esophageal stricture who have recurrent symptoms of dysphagia.

The research team reviewed best practice advice 3, which recommends upper endoscopy in men older than 50 years with chronic GERD symptoms, and additional risk factors to detect esophageal adenocarcinoma and Barrett esophagus.

Upper endoscopy is also indicted for surveillance evaluation in men and women with a history of Barrett esophagus.

The team report that in men and women with Barrett esophagus and no dysplasia, surveillance examinations should occur at intervals no more frequently than 3 to 5 years.

More frequent intervals are indicated in patients with Barrett esophagus and dysplasia.

Endoscopy is indicated in typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy.

Severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy indicates endoscopy to assess healing and rule out Barrett esophagus.

Recurrent endoscopy after this follow-up examination is not indicated in the absence of Barrett esophagus.

The research team reports that surveillance is indicated in patients with a history of esophageal stricture who have recurrent symptoms of dysphagia.

Surveillance is also indicated in men older than 50 years with chronic GERD symptoms, and additional risk factors to detect esophageal adenocarcinoma and Barrett esophagus.

Surveillance evaluation is further indicated in men and women with a history of Barrett esophagus.

In men and women with Barrett esophagus and no dysplasia, surveillance examinations should occur at intervals no more frequently than 3 to 5 years.

More frequent intervals are indicated in patients with Barrett esophagus and dysplasia.

The team report that upper endoscopy is commonly used in the diagnosis and management of gastroesophageal reflux disease (GERD).

Dr Shaheen's team concludes, "The Clinical Guidelines Committee of the American College of Physicians reviewed evidence regarding the indications for, and yield of, upper endoscopy in the setting of GERD to highlight how clinicians can increase delivery of high-value care."

"This article reviews their best practice advice."