Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians.

Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians.

MedLine Citation:	PMID: 23208168 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: 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. METHODS: 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, and to highlight how clinicians can increase the delivery of high-value health care. BEST PRACTICE ADVICE 1: Upper endoscopy is indicated in men and women with heartburn and alarm symptoms (dysphagia, bleeding, anemia, weight loss, and recurrent vomiting). BEST PRACTICE ADVICE 2: 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. 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. History of esophageal stricture who have recurrent symptoms of dysphagia. BEST PRACTICE ADVICE 3: Upper endoscopy may be indicated: In men older than 50 years with chronic GERD symptoms (symptoms for more than 5 years) and additional risk factors (nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use, and intra-abdominal distribution of fat) to detect esophageal adenocarcinoma and Barrett esophagus. For surveillance evaluation 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.

Authors:	Nicholas J Shaheen; David S Weinberg; Thomas D Denberg; Roger Chou; Amir Qaseem; Paul Shekelle;
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Publication Detail:	Type: Journal Article; Practice Guideline; Research Support, N.I.H., Extramural
Journal Detail:	Title: Annals of internal medicine Volume: 157 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2012 Dec
Date Detail:	Created Date: 2012-12-04 Completed Date: 2013-02-08 Revised Date: 2013-05-20
Medline Journal Info:	Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States
Other Details:	Languages: eng Pagination: 808-16 Citation Subset: AIM; IM
Affiliation:	University of North Carolina School of Medicine, CB#7080, Room 4150, 130 Mason Farm Road, Chapel Hill, NC 27599-7080, USA.
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MeSH Terms
Descriptor/Qualifier:	Adenocarcinoma / diagnosis Barrett Esophagus / diagnosis Chronic Disease Endoscopy, Gastrointestinal / adverse effects, utilization* Esophageal Neoplasms / diagnosis Female Gastroesophageal Reflux / complications, diagnosis*, drug therapy, etiology Health Care Costs Humans Male Middle Aged Precancerous Conditions / diagnosis Proton Pump Inhibitors / therapeutic use Risk Factors Unnecessary Procedures / economics
Grant Support
ID/Acronym/Agency:	U54CA156733/CA/NCI NIH HHS; U54CA163060/CA/NCI NIH HHS
Chemical
Reg. No./Substance:	0/Proton Pump Inhibitors
Investigator
Investigator/Affiliation:	Paul Shekelle / ; Roger Chou / ; Paul Dallas / ; Thomas D Denberg / ; Nick Fitterman / ; Mary Ann Forciea / ; Robert H Hopkins / ; Linda L Humphrey / ; Tanveer P Mir / ; Holger J Schünemann / ; Donna E Sweet / ; David S Weinberg /
Comments/Corrections
Comment In:	Ann Intern Med. 2013 Mar 19;158(6):502-3 [PMID: 23552463 ] Ann Intern Med. 2013 Mar 19;158(6):503-4 [PMID: 23552485 ]
Summary for patients in:	Ann Intern Med. 2012 Dec 4;157(11):I-28 [PMID: 23208179 ]

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