Management of symptoms of gastroesophageal reflux disease: does endoscopy influence medical management?
OBJECTIVE
The purpose of this study was to examine the theories that underlie the clinical decision to perform endoscopy in patients with symptoms of gastroesophageal reflux disease (GERD). Physicians reported that they use endoscopic findings to modify medical treatment of GERD. This study was undertaken to test this hypothesis in clinical practice.


METHODS
A consortium of community specialists in gastrointestinal disease was formed. Physicians completed a database on patients undergoing elective endoscopy for symptoms of GERD, which includes symptom severity, endoscopic findings, and medical treatment before and after endoscopy. An increase in medical treatment was defined as an increase in acid suppression therapy, and/or the addition of a promotility drug, and/or referral for surgery.


RESULTS
Data were collected prospectively over 6 months on 664 patients with symptoms of GERD, and complete data were available on 598 patients. Barrett's esophagus or active esophagitis (erythema, erosions, or ulceration) was present in 374 patients. Of these patients, 74% had an increase in therapy after endoscopy; for only 5% did therapy decrease. In contrast, among 224 patients with a normal-appearing esophagus, 35% had an increase in treatment and 65% had either a decrease in treatment or no change. In most cases, the increase in treatment was due to persistence of symptoms or because of endoscopic findings in the stomach or duodenum. The differences in treatment changes between the two groups was highly significant (p < 0.0001).


CONCLUSIONS
The results support the theory that physicians often use endoscopic results to tailor medical therapy in patients with symptoms of GERD.
Ellis
K K
KK
Department of Medicine, Oregon Health Sciences University, and Portland Veterans Affairs Medical Center, 97207, USA.
Oehlke
M
M
Helfand
M
M
Lieberman
D
D
D000863:Antacids / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D003657:Decision Making; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000473:pathology; D004382:Duodenitis / Q000188:drug therapy / Q000473:pathology; D004890:Erythema / Q000473:pathology; D004941:Esophagitis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D004942:Esophagitis, Peptic / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005756:Gastritis / Q000188:drug therapy / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007256:Information Systems; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012017:Referral and Consultation; D012720:Severity of Illness Index; D013276:Stomach Ulcer / Q000188:drug therapy / Q000473:pathology; D014456:Ulcer / Q000473:pathology
D000863:Antacids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors