The Right Time for Endoscopy

Heartburn and acid reflux guidelines show when having upper endoscopy is most needed

(RxWiki News) When medicines and pumps don't work to reduce heartburn and acid reflux, what can you do? Having a doctor look down the hatch may be the next step.

But getting the tube down the throat too often under various conditions can add extra costs without helping the patient, a new study has found.

"Watch for fever, chest pain and shortness of breath after medical procedures."

Upper endoscopy is regularly used to figure out if patients have heartburn or Barrett's esophagus, which happens when the lining of the tube that goes from the mouth (esophagus) to the stomach starts to resemble the intestines. A tiny camera attached to a flexible tube is inserted down the upper part of the digestive system in the procedure.

A paper co-authored by Nicholas Shaheen, MD, MPH, professor of medicine and epidemiology in the School of Medicine at the University of North Carolina at Chapel Hill, the American College of Physicians (ACP) looked at the conditions under which patients were examined for the two conditions.

They also aimed to see how clinicians could be more efficient in giving high-value health care.

After reviewing the information, researchers advise that upper endoscopy be used:

  • in both male and female patients with heartburn with various alarm symptoms
  • in patients with long-term problems who continue to have acid reflux even after a month to two months of treatment
  • in men older than 50 years of age who have long-term acid reflux symptoms to check for cancer and other problems in the esophagus

"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," said David Bronson, MD, FACP, president of the ACP, in a press release.

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

They especially advise patients who are largely overweight, use tobacco products, or have hernias or problems with heartburn at night to have the procedure.

Each endoscopic procedure costs more than $800 on average. Naturally, researchers said that doing the procedure for the wrong reasons or too often can increase the chances that some complication would happen, though the procedure is low risk to begin with.

"Its use in GERD should be carefully limited to these situations to avoid repetitive, low-yield endoscopy that has little effect on clinical management to improve patient care and reduce healthcare costs," said Maxwell Chait, a gastroenterologist with ColumbiaDoctors Medical Group and dailyRx Contributing Expert.

"Hopefully, these guidelines will help physicians decide how best to manage patients in a manner that provides excellent care and uses resources wisely. Further research is needed in this area to better define populations at risk that will better target upper GI endoscopy."

The study, which was supported by the American College of Physicians and the National Cancer Institute, was published online December 4 in the Annals of Internal Medicine.

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Review Date: 
December 6, 2012