Nicholas J. Shaheen, MD, MPH; David S. Weinberg, MD, MSc; Thomas D. Denberg, MD, PhD; Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Paul Shekelle, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians*
Note: Best practice advice papers are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP best practice advice papers are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Disclaimer: The authors of this best practice advice paper are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of Veterans Affairs.
Financial Support: Financial support for the development of this best practice advice paper comes exclusively from the ACP's operating budget. Dr. Shaheen is supported by the National Cancer Institute (grant U54CA163060 and U54CA156733).
Potential Conflicts of Interest: Any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved according to ACP's conflicts of interest policy. A record of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0618.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Current Author Addresses: Dr. Shaheen: University of North Carolina School of Medicine, CB#7080, Room 4150, 130 Mason Farm Road, Chapel Hill, NC 27599-7080.
Dr. Weinberg: Department of Medicine, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111.
Dr. Denberg: Harvard Vanguard Medical Associates, 275 Grove Street, Auburndale, MA 02466.
Dr. Chou: Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: BICC, Portland, OR 97239.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Shekelle: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.
Author Contributions: Conception and design: N.J. Shaheen, D.S. Weinberg, T.D. Denberg, R. Chou, A. Qaseem, P. Shekelle.
Analysis and interpretation of the data: N.J. Shaheen, D.S. Weinberg, T.D. Denberg, R. Chou, A. Qaseem.
Drafting of the article: N.J. Shaheen, D.S. Weinberg, T.D. Denberg, R. Chou, A. Qaseem.
Critical revision of the article for important intellectual content: N.J. Shaheen, D.S. Weinberg, T.D. Denberg, R. Chou, A. Qaseem, P. Shekelle.
Final approval of the article: N.J. Shaheen, D.S. Weinberg, T.D. Denberg, R. Chou, A. Qaseem, P. Shekelle.
Statistical expertise: A. Qaseem.
Obtaining of funding: D.S. Weinberg.
Administrative, technical, or logistic support: D.S. Weinberg, A. Qaseem.
Collection and assembly of data: N.J. Shaheen, D.S. Weinberg.
Also available: Consumer Reports Patient Resource on High-Value Care for GERD
Upper endoscopy is commonly used in the diagnosis and management of gastroesophageal reflux disease (GERD). Evidence demonstrates that it is indicated only in certain situations, and inappropriate use generates unnecessary costs and exposes patients to harms without improving outcomes.
The Clinical Guidelines Committee of the American College of Physicians reviewed evidence regarding the indications for, and yield of, upper endoscopy in the setting of GERD, and to highlight how clinicians can increase the delivery of high-value health care.
Upper endoscopy is indicated in men and women with heartburn and alarm symptoms (dysphagia, bleeding, anemia, weight loss, and recurrent vomiting).
Upper endoscopy is indicated in 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.
Severe erosive esophagitis after a 2-month course of proton-pump inhibitor 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.
History of esophageal stricture who have recurrent symptoms of dysphagia.
Upper endoscopy may be indicated:
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.
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.
Shaheen NJ, Weinberg DS, Denberg TD, Chou R, Qaseem A, Shekelle P, et al. Upper Endoscopy for Gastroesophageal Reflux Disease: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. ;157:808–816. doi: 10.7326/0003-4819-157-11-201212040-00008
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Published: Ann Intern Med. 2012;157(11):808-816.
Esophageal Disorders, Gastroenterology/Hepatology, Gastroesophageal Reflux Disease, Guidelines, High Value Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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