Is Upper Endoscopy Overused for GERD?

Upper GI endoscopy is often used in the screening of patients who suffer from gastroesophageal reflux disease (GERD), but recently issued recommendations from the American College of Physicians suggest that the procedure may be overused.

Esophageal endoscopy should not be a routine treatment for heartburn in men under 50 years or in women of any age, the recommendations state, due to the low risk of esophageal cancer among these patient populations.

"Inappropriate use of upper endoscopy does not improve the health of patients, exposes them to preventable harms, may lead to additional unnecessary interventions, and results in unnecessary costs with no benefit," says ACP President David L. Bronson, MD, FACP.

Upper endoscopy should be considered a best practice for acid reflux only when patients exhibit related conditions. "The evidence indicates that upper endoscopy is indicated in patients with heartburn only when accompanied by other serious symptoms such as difficult or painful swallowing, bleeding, anemia, weight loss, or recurrent vomiting," says Dr. Bronson. "The procedure is not an appropriate first step for most patients with heartburn."

The recommendations, drafted by the ACP's clinical guidelines committee, appeared in the Dec. 4 issue of the journal Annals of Internal Medicine and were supported by an editorial.

David Bernard