The ACP indications for EGD in patients with GERD.
1)Alarm symptoms: Men and women with heartburn and alarm symptoms (dysphagia, bleeding, anemia, weight loss, and recurrent vomiting).
2)Failed PPI therapy: Men and women with typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy.
3)Severe erosive esophagitis after a 2-month course of PPI therapy to assess healing and rule out Barrett esophagus. Recurrent endoscopy after this follow-up examination is not indicated in the absence of Barrett esophagus.
4) Hx of Esophageal stricture: History of esophageal stricture who have recurrent symptoms of dysphagia
5) In men older than 50 years with chronic GERD symptoms (symptoms for more than 5 years) and additional risk factors (nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use, and intra-abdominal distribution of fat) to detect esophageal adenocarcinoma and Barrett esophagus. Screening EGD is not recommended for women of any age or for men aged < 50 years.
6) Hx of Barretts esophagus: For surveillance evaluation in men and women with a history of Barrett esophagus. In men and women with Barrett esophagus and no dysplasia, surveillance examinations should occur at intervals no more frequently than 3 to 5 years. More frequent intervals are indicated in patients with Barrett esophagus and dysplasia.
*** Not From ACP recommendation: EGD may be ordered if the diagnosis of GERD is unclear.
From the American Society of Gastrointestinal Endoscopy (ASGE) – 2015
- GERD symptoms that are persistent or progressive despite appropriate medical therapy
- Dysphagia or odynophagia
- Involuntary weight loss > 5%
- Evidence of GI bleeding or anemia
- Finding of a mass, stricture, or ulcer on imaging studies
- Screening for Barrett’s esophagus in selected patients (as clinically indicated)
- Persistent vomiting (7-10 days)
- Evaluation of patients before or with recurrent symptoms after endoscopic or surgical antireflux procedures
- Placement of wireless pH monitoring
References
http://annals.org/aim/article/1470281/upper-endoscopy-gastroesophageal-reflux-disease-best-practice-advice-from-clinical (published 2012)
https://www.asge.org/docs/default-source/education/practice_guidelines/doc-endoscopy_in_the_managment_of_gerd.pdf (published 2015)
http://www.aafp.org/afp/2013/1215/p865.html
http://www.medscape.com/viewarticle/777605_5
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