title: Primary care physician attitudes toward endoscopic screening for GERD symptoms and unsedated esophagoscopy.
abstract: BACKGROUND
  Current guidelines recommend consideration of screening patients with chronic GERD for Barrett's esophagus (BE). Unsedated esophagoscopy (UE) is a less costly alternative to standard EGD for identifying BE. The aim of this study was to determine the indications for EGD referral, the barriers to screening, and the interest in performing UE.
  
  
  METHODS
  A one-page survey was mailed to a random sample of 500 family practitioners and 500 internists. This sample was obtained from the American Academy of Family Physicians and American Society of Internal Medicine (500 from each organization).
  
  
  RESULTS
  The overall response rate was 54%. The majority (78%) refer more than 50% of their GERD patients for EGD; however, 34% also refer more than 10% of their patients for barium studies. Primary care physicians cited alarm symptoms, refractory symptoms, and chronicity and severity of symptoms as the major indications for referral for EGD. Gender, age, obesity, and tobacco use were cited less frequently. Cost of endoscopy, poor patient acceptance, and lack of evidence were the most common reasons cited for not referring for EGD. A majority of respondents (62%) indicated that the availability of UE would increase referral for the procedure, and 52% would be willing to perform UE in their office.
  
  
  CONCLUSIONS
  Severe, refractory, and chronic symptoms are the primary reasons for endoscopic referral from primary care physicians who manage patients with GERD. Other risk factors for BE, such as gender and age, do not appear to be important determinants for endoscopic referral. Further evaluation of UE as a mechanism to increase screening for BE in primary care patients is merited.
authors.affiliation: Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Boolchand
authors.forename: Ashley
authors.initials: A
authors.lastname: Faulx
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.forename: Stephen
authors.initials: S
authors.lastname: Zyzanski
authors.forename: Gerard
authors.initials: G
authors.lastname: Isenberg
authors.forename: Gregory
authors.initials: G
authors.lastname: Cooper
authors.forename: Michael V
authors.initials: MV
authors.lastname: Sivak
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
mesh_terms: D001291:Attitude of Health Personnel; D016292:Procedural Sedation; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000592:standards; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011795:Surveys and Questionnaires; D014481:United States