The Yield and Impact of Upper Endoscopy in a Diverse Population with Refractory GERD

Abstract

Purpose: Several studies have suggested that EGD may alter the management of patients with reflux symptoms. It remains unclear whether the benefit of EGD is consistent across ethnic groups given the lower prevalence of Barrett's esophagus in minority populations. The aim of this study was to determine the yield of EGD and its impact on the management of GERD in a multi-ethnic cohort with refractory symptoms. Methods: All ambulatory patients who completed upper endoscopy for heartburn between July 2002 and December 2004 in a large municipal hospital were reviewed. The study cohort consisted only of patients with persistent heartburn despite at least 6 weeks of PPI therapy. Pre-procedure demographic and clinical data was collected and patients were grouped according to the presence of alarm symptoms (dysphagia, odynophagia, GI bleeding, weight loss, or iron deficiency anemia). Reflux complications were defined as grade 2 or above esophagitis, Barrett's esophagus >3 cm, or esophageal stricture. GERD management was considered to be altered if there was a change in antisecretory therapy, stricture dilation, Barrett's surveillance initiated, or referral to surgery. Results: A total of 263 patients (mean age 53 ± 12 years) met inclusion criteria of which 33 (13.6%) were Caucasian, 21 (8.6%) were African American, 149 (61.3%) were Hispanic, and 40 (16.5%) were Asian or of Middle Eastern descent. Although reflux complications (RC) were highest among Caucasians compared to non-Caucasians, the difference was not significant (15%vs. 14% p = 0.83). The prevalence of RC in the 78 patients with alarm symptoms was not significantly different from the 185 patients without alarm symptoms (13%vs. 15% p = 0.69). EGD altered GERD management in 35% of patients although only 14% of individuals had RC. The 34 patients with RC were significantly more likely to have any alteration in management compared to the 229 patients without RC (56%vs. 31% p = 0.006). Although the prevalence of RC did not differ according to gender, among those with RC women were significantly more likely to have alteration in management when compared to men (72%vs. 38% p = 0.042). Conclusions: In this diverse population with refractory GERD, reflux complications did not differ according to gender, ethnicity or the presence of alarm symptoms. EGD significantly altered management especially in women with esophageal findings. Further studies to evaluate predictors of reflux complications and gender differences in management in multi-ethnic populations are warranted.