Endoscopy in GERD: Boondoggle, Diagnostic Test, or Risk Management Tool?

Abstract

The role of endoscopy in reflux disease is debated. Diagnostic certainty is attractive to patients and physicians, to affirm health and to ensure the absence of serious disease, but it is expensive and the majority of patients will have no endoscopic abnormalities. Empirical treatment with acid suppression in patients with symptoms of gastroesophageal reflux disease (GERD) is now widely practiced in primary care in many countries but in others, endoscopy is mandatory to receive approval from the payors for proton pump inhibitor therapy. In patients with dysphagia, endoscopy has a role in ruling out an obstructing lesion. A "once-in-a-lifetime" endoscopy has been proposed as a way to improve our ability to diagnose Barrett's esophagus, but cost-models suggest that this strategy is not cost-effective if current surveillance guidelines are followed after the diagnosis of Barrett's esophagus is made. The role of routine endoscopic examination in GERD is therefore questionable and needs better definition in carefully designed trials.