Upper endoscopy oversued for heartburn

Heartburn is one of the most common reasons for people to see a doctor, and some physicians often use upper endoscopy to diagnose and manage gastroesophageal reflux disease (GERD). But most patients do not require the procedure unless other serious symptoms are present, according to the American College of Physicians (ACP) Clinical Guidelines Committee in a new evidence-based clinical policy paper published December 3 in Annals of Internal Medicine.

"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 L. Bronson, MD, FACP, president, ACP. "The procedure is not an appropriate first step for most patients with heartburn."

ACP advises that screening with upper endoscopy should not be routinely performed in women of any age or in men under the age of 50 with heartburn because the incidence of cancer is very low in these populations.

Upper endoscopy is indicated in patients with heartburn who are unresponsive to medicine (proton pump inhibitors) to reduce gastric acid production for a period of four to eight weeks or who have a history of narrowing or tightening of the esophagus with recurrent difficult or painful swallowing.