Document Detail

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    
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.
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    
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
Adenocarcinoma / diagnosis
Barrett Esophagus / diagnosis
Chronic Disease
Endoscopy, Gastrointestinal / adverse effects,  utilization*
Esophageal Neoplasms / diagnosis
Gastroesophageal Reflux / complications,  diagnosis*,  drug therapy,  etiology
Health Care Costs
Middle Aged
Precancerous Conditions / diagnosis
Proton Pump Inhibitors / therapeutic use
Risk Factors
Unnecessary Procedures / economics
Grant Support
Reg. No./Substance:
0/Proton Pump Inhibitors
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 /
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 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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