Upper Endoscopy Overused in Patients with Acid Reflux

Most patients experiencing heartburn, also called acid reflux, do not need the commonly used screening procedure known as endoscopy unless there are other critical symptoms exhibited, suggests new research in a clinical policy paper published in the journal Annals of Internal Medicine.

Heartburn is one of the most common issues leading people to seek a doctor's advice. Physicians often use upper endoscopy to diagnose and control gastroesophageal reflux disease (GERD), as it can increase the risk of esophageal cancer.

Upper endoscopy involves putting a long, flexible tube down into the throat and taking pictures of the esophagus, stomach and other parts of the gastrointestinal tract.

David L. Bronson, MD, FACP, president, ACP, said:

"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. The procedure is not an appropriate first step for most patients with heartburn."

The American College of Physicians (ACP) recommends that screening using upper endoscopy should not be regularly conducted in women of any age or in men under the age of 50 with heartburn because the prevalence of cancer is extremely low in these populations.

Upper endoscopy is generally used for patients with acid reflux who do not respond to medicine (proton pump inhibitors) to decrease gastric acid production for a period of four to eight weeks, or who have in the past experienced narrowing or constricting of the esophagus with repeated painful or tough swallowing.

For men over 50 years of age, upper endoscopy screening should be used when multiple risk factors for Barrett's esophagus are seen. They include the following:

• nocturnal reflux symptoms
• hernia
• tobacco use
• fat within abdominal cavity
• elevated body mass index

If the first screening test for Barrett's esophagus or esophageal cancer is negative, recurrent periodic upper endoscopy is not suggested.

For patients who have Barrett's esophagus, upper endoscopy is recommended every three to five years. Continual endoscopic tests are suggested for patients with low- or high-grade dysplasia, because of the increased risk of developing cancer.

Doctors should make use of education programs to inform patients about up-to-date and effective standards of care. Medication is ideal to decrease gastric acid creation in the majority of patients with classic GERD symptoms like regurgitation or heartburn.

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

Certain components that play a part in overuse of upper endoscopy include the following:

• patient and caregiver expectations
• medico-legal liability concerns
• professional medical organizations

Extra and pointless expenses include the procedure itself (excess of $800 per exam) when it is recommended, as well as the flood of costs from follow up tests because of an original misdiagnosis.

Also, previous research has told us there may be severe complications that occur with endoscopy. These complications can result in additional hospital visits, increased costs, and potentially life-threatening situations.

Written by Kelly Fitzgerald
Source:MNT