COMMENTARY

Top 10 Practice-Changing Articles of 2012: Gastroenterology

David A. Johnson, MD

Disclosures

January 16, 2013

In This Article

Upper Endoscopy for Gastroesophageal Reflux Disease: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

Shaheen NJ, Weinberg DS, Denberg TD, et al
Ann Intern Med. 2012;157:808-816

Referral for Esophagogastric Duodenoscopy

With this guideline, the American College of Physicians provides best practice advice to clinicians on appropriate referral indications for esophagogastric duodenoscopy (EGD) in patients with gastroesophageal reflux disease (GERD). The indications are as follows:

  • Patients with GERD and "alarm symptoms" (eg, dysphagia, bleeding, vomiting, weight loss, anemia).

  • Patients with:

    • Persistent GERD symptoms despite twice-daily use of proton-pump inhibitor therapy for 4-8 weeks;

    • Severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out BE;

    • History of esophageal stricture with recurrent dysphagia symptoms; or

    • Established BE (if no dysplasia, surveillance interval not to exceed 3-5 years).

  • Men aged ≥ 50 years with chronic GERD symptoms (> 5 years) and additional risk factors (nocturnal GERD, hiatal hernia, increased body mass index, intra-abdominal fat distribution, and tobacco use).

Screening EGD is not recommended for women of any age or for men aged < 50 years.

Viewpoint

EGD is overused in patients with GERD for several reasons, including concern about medical malpractice for missed diagnoses, and open-access referral for EGD from primary care physicians. These clear, pragmatic guidelines should lay the foundation for cost-effective and appropriate utilization of EGD in patients with GERD.

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