Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 10 February 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

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.

News image

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."

Ann Int Med 2012: 157(11): 808-816
06 December 2012

Go to top of page Email this page Email this page to a colleague

 10 February 2016 
NAFLD in Veterans in the USA
 10 February 2016 
Rectosigmoidoscopy vs colonoscopy in ulcerative colitis
 10 February 2016 
Liver cancer and primary biliary cirrhosis
 09 February 2016 
Cancer-specific prognosis in octogenarians with colorectal cancer
 09 February 2016 
Eosinophilic esophagitis and parental allergies
 09 February 2016 
Bowel preparation for colonoscopy screening
 08 February 2016 
Immunity in the human gut
 08 February 2016 
Cancelled colonoscopy appointments
 08 February 2016 
Cognitive function in Crohn's disease
 05 February 2016 
Helicobacter cinaedi bacteremia
 05 February 2016 
Methotrexate and remission in ulcerative colitis
 05 February 2016 
Treatment for ileal pouch-anal anastomosis for Crohn’s colitis
 04 February 2016 
Diabetes and liver cancer
 04 February 2016 
Colorectal cancer screening
 04 February 2016 
H. pylori and coronary heart disease 
 03 February 2016 
Acute diverticulitis and IBS 
 03 February 2016 
Microbiota of the colonic mucosa and chronic constipation
 03 February 2016 
Guidelines for chronic pancreatitis
 02 February 2016 
Ramosetron and IBS-diarrhea
 02 February 2016 
IBD emergency department visits
 02 February 2016 
Probiotics for H. pylori management
 01 February 2016 
Depressive symptoms in IBD 
 01 February 2016 
Obesity and hepatocellular carcinoma risk
 01 February 2016 
Managing HBV in pregnancy
 29 January 2016 
Colorectal cancer after colonoscopy
 29 January 2016 
Acute diverticulitis in immunosuppressed patients
 29 January 2016 
Vitamin D and colorectal cancer risk
 28 January 2016 
Tissue anti-TNF drug levels and IBD
 28 January 2016 
First line treatment of H. pylori infection
 28 January 2016 
Tetracycline for rosacea increases the risk of IBD
 27 January 2016 
Steroids in children with Crohn's
 27 January 2016 
Self-management IBS program 
 27 January 2016 
Human gut microbiome in IBD 
 26 January 2016 
Smoking and symptomatic diverticular disease
 26 January 2016 
Step-down therapy in PPI-responsive esophageal eosinophilia 
 26 January 2016 
Diet and IBD risk
 25 January 2016 
IBD monitoring using smartphones
 25 January 2016 
Self-management IBS program
 25 January 2016 
Colorectal cancer after a negative screening sigmoidoscopy
 22 January 2016 
Length of Barrett's and cancer
 22 January 2016 
Psychosocial interventions and alcohol abstinence in chronic liver disease
 22 January 2016 
Helicobacter pylori antibiotic resistance
 21 January 2016 
Increasing adenoma detection rate during colonoscope withdrawal
 21 January 2016 
Microscopic colitis current concepts
 21 January 2016 
Statins as a management strategy for constipation 
 20 January 2016 
Health status after bariatric surgery
 20 January 2016 
Hep E infection in West Africa
 20 January 2016 
Preventing endoscopic bacterial transmission
 19 January 2016 
PPIs and phlebotomy in hereditary hemochromatosis
 19 January 2016 
Predicting liver cirrhosis in Hep C
 19 January 2016 
Frozen vs fresh fecal microbiota transplantation
 18 January 2016 
Hospitalization for diverticulitis in the USA
 18 January 2016 
H. pylori and gastric cancer across Europe
 18 January 2016 
Enteral nutrition in children with Crohn's
 15 January 2016 
Alcohol- and HCV-related hepatocellular carcinoma
 15 January 2016 
Recurrent colonic diverticulitis
 15 January 2016 
Colonic diverticula and colorectal cancer risk
 14 January 2016 
Risk stratification of incidentally discovered gallstones
 14 January 2016 
Treatment of refractory cholestatic pruritus
 14 January 2016 
Colonic diverticula and colorectal cancer risk 

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us