title: Clinical impact of upper endoscopy in the management of patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  Esophago-gastro-duodenoscopy (EGD) is frequently performed in patients with heartburn. However, the benefit of an EGD is unclear. The objective is to determine the clinical impact of performing an EGD in the management of GERD.
  
  
  METHODS
  Patients with alarm symptoms or persistent heartburn from primary care and gastroenterology clinics were invited to participate. Patients with known reflux complications or an EGD procedure within 3 yr were excluded. Endpoints for EGD-improving management were prospectively defined: change in medical therapy, dilating esophageal stricture, identifying Barrett's esophagus (BE), finding severe esophagitis (Hetzel-Dent grade 3 or 4), or finding cancer.
  
  
  RESULTS
  Two hundred and six patients (59 M/147 F; median age, 48 yr) were enrolled, in which, 124 had alarm symptoms and 82 had persistent heartburn. EGD improved the overall management in 40% of patients with alarm symptoms and 29% with persistent heartburn (p= NS). Medical therapy was altered in only 5% of patients, and no cancer was identified. EGD was more likely to improve management in males with alarm symptoms.
  
  
  CONCLUSIONS
  It was uncommon for an EGD to alter antireflux therapy. The management was improved in approximately one-third of the patients by dilating esophageal stricture, finding BE to initiate surveillance, or finding severe esophagitis. EGD should be performed when alarm symptoms are present, especially in males.
authors.affiliation: Division of Gastroenterology/Hepatology, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Wo
authors.forename: Christian
authors.initials: C
authors.lastname: Mendez
authors.forename: Steve
authors.initials: S
authors.lastname: Harrell
authors.forename: Rauol
authors.initials: R
authors.lastname: Joubran
authors.forename: Phillip F
authors.initials: PF
authors.lastname: Bressoud
authors.forename: William Paul
authors.initials: WP
authors.lastname: McKinney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome