Pretreatment Endoscopy - Pro & Contra: Is Endoscopy Needed before Treatment in All Patients with Gastroesophageal Reflux Disease?

The role of endoscopy in reflux disease has changed from being primarily diagnostic to one of risk management. Objective studies of routine endoscopy have shown little change in outcomes after the examination. Screening and surveillance for Barrett’s esophagus is still an unconfirmed strategy. In most developed countries, including western Europe and North America, middle-aged patients (over the age of 50) with gastroesophageal reflux disease would benefit more from colonoscopy than upper endoscopy.

References

• 1 Pace F, Manes G, Conio M, Bianchi Porro G. Endoscopy is needed before treatment in all patients with gastroesophageal reflux disease.  Endoscopy. 2006;  38 271-275
• 2 van Pinxteren B, Numans M E, Bonis P A, Lau J. Short-term treatment with proton pump inhibitors, H₂-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease.  Cochrane Database Syst Rev. 2001;  4 CD002095
• 3 National Institute for Clinical Excellence .Dyspepsia: management of dyspepsia in adults in primary care. Clinical guideline 17. London; National Institute for Clinical Excellence 2004 http://(www. nice. org. uk/CG017NICEguideline)
• 4 Spiegel B M, Ofman J J, Woods K, Vakil N. Minimizing recurrent peptic ulcer hemorrhage after endoscopic hemostasis: the cost-effectiveness of competing strategies.  Am J Gastroenterol. 2003;  98 86-97
• 5 Moayyedi P, Delaney B C, Vakil N. et al . The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis.  Gastroenterology. 2004;  127 1329-1337
• 6 Vakil N. How valuable are proton-pump inhibitors in establishing a diagnosis of gastro-oesophageal reflux disease?.  Aliment Pharmacol Ther. 2005;  22 (Suppl 1) 64-69
• 7 Veldhuyzen van Zanten S J, Bradette M, Chiba N. et al . Evidence-based recommendations for short- and long-term management of uninvestigated dyspepsia in primary care: an update of the Canadian Dyspepsia Working Group (CanDys) clinical management tool.  Can J Gastroenterol. 2005;  19 285-303
• 8 Smith T, Verzola E, Mertz H. Low yield of endoscopy in patients with persistent dyspepsia taking proton pump inhibitors.  Gastrointest Endosc. 2003;  58 9-13
• 9 Blustein P, Beck P, Meddings J. et al . The utility of endoscopy in the management of patients with gastroesophageal reflux symptoms.  Am J Gastroenterol. 1998;  93 2508-2512
• 10 McDougall N, Johnston B, Kee F. et al . Natural history of reflux esophagitis: a 10-year follow-up of the effects on patient symptomatology and quality of life.  Gut. 1996;  38 481-486
• 11 Isolauri J, Luostarinen M, Isolauri E. et al . Natural course of gastroesophageal reflux disease: 17-22 year follow-up of 60 patients.  Am J Gastroenterol. 1997;  92 37-41
• 12 MacDonald C E, Wicks A C, Playford R J. Final results from a 10-year cohort of patients undergoing surveillance for Barrett’s esophagus: observational study.  Br Med J. 2000;  321 1252-1255
• 13 Van der Burgh A, Dees J, Hop W CJ, van Blankenstein M. Esophageal cancer is an uncommon cause of death in patients with Barrett’s esophagus.  Gut. 1996;  39 5-8
• 14 Meining A, Ott R, Becker I. et al . The Munich Barrett follow-up study: suspicion of Barrett’s esophagus based on either endoscopy or histology only - what is the clinical significance?.  Gut. 2004;  53 1402-1407
• 15 Lagergren J, Ye W, Bergstrom R, Nyren O. Utility of endoscopic screening for upper gastrointestinal adenocarcinoma.  JAMA. 2000;  284 961-962
• 16 Rex D K, Cummings O W, Shaw M. et al . Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn.  Gastroenterology. 2003;  125 1670-1677
• 17 Inadomi J M, Sampliner R, Lagergren J. et al . Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis.  Ann Intern Med. 2003;  138 176-186
• 18 Quadri A, Vakil N. Health-related anxiety and the effect of open-access endoscopy in US patients with dyspepsia.  Aliment Pharmacol Ther. 2003;  17 835-840
• 19 Johnston B, Guning J, Lewis S. Health care seeking by heartburn sufferers is associated with psychosocial factors.  Am J Gastroenterol. 1996;  91 2500-2504
• 20 Shaheen N J, Dulai G S, Ascher B. et al . Effect of a new diagnosis of Barrett’s esophagus on insurance status.  Am J Gastroenterol. 2005;  100 577-580
• 21 Locke G R 3rd, Talley N J, Fett S L. et al . Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota.  Gastroenterology. 1997;  112 1448-1556
• 22 Corder A P, Jones R H, Sadler G H. et al . Heartburn, oesophagitis and Barrett’s oesophagus in self-medicating patients in general practice.  Br J Clin Pract. 1996;  50 245-248
• 23 Rantanen T K, Salo J A. Gastroesophageal reflux disease as a cause of death: analysis of fatal cases under conservative treatment.  Scand J Gastroenterol. 1999;  34 229-233
• 24 Greenlee R T, Murray T, Bolden S, Wingo P A. Cancer statistics, 2000.  CA Cancer J Clin. 2000;  50 7-33