Is Esophagoscopy Alone Sufficient for Patients with Reflux Symptoms? - Final Results

Abstract

Background: Unsedated esophagoscopy with ultrathin endoscopes is a valuable tool for screening for Barretts esophagus but the smallest and best tolerated of these endoscopes are incapable of complete evaluation of the stomach and duodenum. There is no data clarifying how often disease in stomach and duodenum would be missed using this strategy. We hypothesized that patients with reflux symptoms, in the absence of daily abdominal pain, nausea or history of ulcer, were unlikely to have clinically significant gastroduodenal pathology. Methods: Patients scheduled for upper endoscopy at a single outpatient endoscopy laboratory were screened. Inclusion criteria were reflux symptoms as the primary indication for upper endoscopy. Patients with another valid indication were excluded. A detailed history and symptom questionnaire was prospectively recorded prior to endoscopy for each patient and compared to the endoscopy findings. Results: One hundred and seventy-five patients were included in the study. Indications for upper endoscopy were worsening symptoms (n=74), ongoing reflux despite therapy (n=27), and longstanding reflux (n=74). Major esophageal findings were found in 95 patients. In 10 patients major gastric or duodenal findings were detected (erosive gastritis n=8, gastric ulcer n=2, duodenal ulcer n=2, erosive duodenitis n=2, duodenal polyp n=1). Daily mild abdominal pain (p=0.002) or daily mild nausea (p=0.028) was associated with major gastric/duodenal pathology. Patients with neither daily mild abdominal pain, nausea nor a history of gastric/duodenal ulcer were much less likely to have a major pathology (0.9%) than patients with one of these predictors (13.2%, p=0.00097). Conclusion: Daily mild abdominal pain and nausea in combination with a history of ulcer disease are strong predictors of a major gastric or duodenal pathology. Reflux patients without these predictors are very unlikely to have a major pathology in the stomach or duodenum and esophagoscopy alone is warranted.