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New Guidelines Urge Limiting Endoscopy for GERD
Date:12/4/2012

ent research on GERD and the use of endoscopy, were published Dec. 4 in the Annals of Internal Medicine.

The guidelines point to two other groups that should receive an upper endoscopy. One is people who experience GERD along with symptoms including vomiting and difficulty swallowing, which can be signs of treatable conditions, such as narrowing of the esophagus.

Upper endoscopy is also recommended for those who continue to have heartburn despite medications.

"Most people with GERD symptoms don't need an upper endoscopy. All they need is treatment, and if the symptoms resolve, that's good therapy and also a diagnostic test," Shaheen said.

"If symptoms are occurring everyday or frequently during the week, it's worth discussing with your physician because you might require [prescription medications like] proton pump inhibitors [PPIs]," Shaheen said. "On the other hand, say that you're having symptoms once a week or every other week after pizza and beer, you might get away just fine with antacid or over-the-counter H2 blockers."

Proton pump inhibitor drugs include Prilosec and Prevacid, while H2 blockers include Tagamet and Zantac.

Dr. Benjamin Havemann, a gastroenterologist in private practice in Austin, Texas, said that lifestyle changes, such as avoiding food and drink before bed, not overeating and elevating the head in bed, can also help reduce heartburn.

Forty percent of adults in the United States report GERD symptoms such as heartburn and regurgitation, according to study background information. And the number of upper endoscopies performed is on the rise.

"There is misusage [of upper endoscopies] -- some who need it aren't getting it, some who don't are. As many as a third of the examinations don't meet the criteria that have been created for appropriate usage," said guidelines author Shaheen.

He attributed misusage to factors including doctors' desire to be exhaustive, patients' expectations, as wel
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