Appropriateness of Upper Gastrointestinal Endoscopy in Patients With Gastroesophageal Reflux Disease (GERD): A Single-Center Experience

Abstract

Introduction: GERD accounts for a large number of outpatient clinic visits and is the most common diagnosis of all presenting GI related complaints. The diagnosis is often made clinically but upper endoscopy is commonly used in its diagnosis and management. In this study, we sought to examine the appropriateness of upper endoscopy in patients with GERD in our center according to guidelines. Methods: We reviewed the records of patients diagnosed with GERD at the East Orange VA Medical Center from 01/2012 to 01/2013 for demographics, duration of symptoms, failure of treatment (twice daily PPI therapy for at least 6-8 weeks with lifestyle changes), presence of alarm symptoms (dysphagia, odynophagia, persistent vomiting, >5% weight loss, GI bleeding, anemia) and reasons for upper endoscopy if performed. Performing endoscopy was judged inappropriate in patients with GERD who did not meet any of the following criteria: failure of medical treatment, presence of alarm symptoms or screening for Barrett’s esophagus (> 50 year old Caucasian males with symptoms >5 years). Fisher’s exact test was used to analyze the influence of demographics on the appropriate use of upper endoscopy. Statistical analysis was done using SPSS. Results: There were 101 patients diagnosed with GERD. Ninety-six had sufficient data for review and were analyzed. Median age was 77 (42-98) years. 49% (47) of patients had endoscopy performed. Among them, 83 (39%) of endoscopies were defined as appropriate. Among the 49 patients who did not have endoscopies, an endoscopy would have been appropriate in 16 (32.7%) of them according to guidelines. On univariate analysis, there was no significant difference by age, race or sex as an influence on appropriate use of upper endoscopies. Conclusion: Upper endoscopy is the most widely used investigative procedure for GERD but its limitations and potential for overuse should be recognized. At our center, 17% of endoscopies performed for the management and treatment of GERD were inappropriate. More studies are needed to explore factors associated with inappropriate use of upper endoscopy in the management of GERD.Table 1: Indications for Upper Endoscopy in Patients With GERD