Although upper endoscopy is commonly used in the diagnosis and management of gastro­esophageal reflux disease (GERD), best-practice advice from the American College of Physicians cautions that this procedure is indicated only in certain situations, and inappropriate use generates unnecessary costs and exposes patients to harms without improving outcomes.

The evidence-based clinical policy paper (Ann Intern Med. 2012;157:808-816) offers three pieces of best-practice advice regarding the appropriate use of upper endoscopy in GERD:

  1. Upper endoscopy is indicated in men and women with heartburn and alarm symptoms (dysphagia, bleeding, anemia, weight loss, and recurrent vomiting)
  2. Upper endoscopy is indicated in men and women with typical GERD symptoms that persist despite four to eight weeks of b.i.d. proton-pump inhibitor (PPI) therapy, severe erosive esophagitis after a two-month course of PPI therapy to assess healing and to rule out Barrett esophagus (in the absence of Barrett esophagus, recurrent endoscopy after this follow-up exam is not indicated), or history of esophageal stricture who have recurrent symptoms of dysphagia
  3. Upper endoscopy may be indicated in men older than age 50 years with chronic GERD symptoms 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. 

Upper endoscopy may also be indicated for surveillance evaluation in men and women with a history of Barrett esophagus. In patients with Barrett esophagus and no dysplasia, surveillance exams should be performed no more often than every three to five years. For patients with Barrett esophagus and dysplasia, more frequent intervals are indicated. 

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