Upper endoscopy is overused in patients with heartburn

December 3, 2012

Heartburn is one of the most common reasons for people to see a doctor, and some physicians often use upper endoscopy to diagnose and manage gastroesophageal reflux disease (GERD). But most patients do not require the procedure unless other serious symptoms are present, according to the American College of Physicians (ACP) Clinical Guidelines Committee in a new evidence-based clinical policy paper published today in Annals of Internal Medicine.

"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," said David L. Bronson, MD, FACP, president, ACP. "The procedure is not an appropriate first step for most patients with heartburn."

ACP advises that screening with upper endoscopy should not be routinely performed in women of any age or in men under the age of 50 with heartburn because the incidence of cancer is very low in these populations.

Upper endoscopy is indicated in patients with heartburn who are unresponsive to medicine () to reduce gastric acid production for a period of four to eight weeks or who have a history of narrowing or tightening of the esophagus with recurrent difficult or painful swallowing.

Screening with upper endoscopy may be indicated in men over 50 with multiple risk factors for Barrett's esophagus, which include heartburn for more than five years, nocturnal reflux symptoms, hiatal hernia, elevated , , and fat within the . If an initial screening exam is negative for Barrett's esophagus or , recurrent periodic upper endoscopy is not indicated.

Among patients found to have Barrett's esophagus, upper endoscopy is indicated every three to five years. More frequent endoscopic examinations are reserved for patients with low- or high-grade dysplasia because of the higher risk of progression to cancer.

Physicians should utilize education strategies to inform patients about current and effective standards of care. Medicine to reduce gastric acid production is warranted in most patients with typical GERD symptoms such as heartburn or regurgitation.

"Inappropriate use of upper endoscopy does not improve the health of , exposes them to preventable harms, may lead to additional unnecessary interventions, and results in unnecessary costs with no benefit," said Dr. Bronson.

Factors that contribute to overuse of upper endoscopy include differing recommendations from professional medical organizations, medico-legal liability concerns, and patient and caregiver expectations.

Unnecessary costs include the procedure itself (excess of $800 per exam) when it is not indicated and downstream costs of unnecessary follow up tests because of an original misdiagnosis.

"Upper Endoscopy for Gastroesophageal Reflux: Best Practice Advice from the American College of Physicians" and a corresponding patient summary appear in the December 4 issue of , published by ACP.

Explore further: Esophageal cancer risk higher in medically treated GERD patients with fewest symptoms

More information: As part of the collaboration between ACP and Consumer Reports, a "High Value Care: Upper Endoscopy for GERD" brochure is available at www.acponline.org/clinical_information/resources/high_value_care/patient_education/ to help patients understand the benefits, harms, and costs of upper endoscopy for GERD.

Related Stories

Reduce esophageal cancer danger by knowing risk factors

August 7, 2012

(Medical Xpress) -- As the American obesity epidemic has increased the past two decades, so has the rate of esophageal cancers. Clinician-scientists affiliated with the University of Cincinnati (UC) Cancer Institute say enhanced ...

Type 2 diabetes may increase the risk of Barrett's Esophagus

October 22, 2012

Patients with Type 2 Diabetes may face an increased risk for Barrett's Esophagus (BE), regardless of other risk factors including smoking, alcohol consumption, obesity and gastroesophageal reflux disease (GERD), according ...

Recommended for you

Monkeys in Asia harbor virus from humans, other species

November 19, 2015

When it comes to spreading viruses, bats are thought to be among the worst. Now a new study of nearly 900 nonhuman primates in Bangladesh and Cambodia shows that macaques harbor more diverse astroviruses, which can cause ...

One-step test for hepatitis C virus infection developed

November 14, 2015

UC Irvine Health researchers have developed a cost-effective one-step test that screens, detects and confirms hepatitis C virus (HCV) infections. Dr. Ke-Qin Hu, director of hepatology services, will present findings at the ...

Computer model reveals deadly route of Ebola outbreak

November 10, 2015

Using a novel statistical model, a research team led by Columbia University's Mailman School of Public Health mapped the spread of the 2014-2015 Ebola outbreak in Sierra Leone, providing the most detailed picture to date ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.