When Should Endoscopy Be Done in the Patient With Reflux?
When Should Endoscopy Be Done in the Patient With Reflux?
Historically, subspecialists have often depended on objective diagnostic tests in the initial management of disease processes (ie, gastroenterologists would use a test such as endoscopy to diagnose gastroesophageal reflux disease [GERD]), whereas primary care physicians (PCPs) have often relied on clinical findings or the results of trials of empirical therapy to make a disease diagnosis. This disparity in initial clinical approach in GERD management between specialist gastroenterologists and PCPs is now especially questionable, given that community-based studies have shown that 40% to 60% of patients with reflux symptoms have no objective endoscopic findings of GERD. Thus, endoscopy only has a sensitivity of approximately 50% for diagnosing GERD. It is my opinion that this relatively modest (at best) sensitivity for endoscopy as a diagnostic test for GERD is underappreciated by many PCPs referring patients with suspected GERD for this procedure as a diagnostic tool. Furthermore, the charges for upper gastrointestinal tract endoscopy and the additional hidden costs (lost productivity, wages, etc, for the patient on the day of the procedure), result in a substantial societal and healthcare system burden financially when endoscopy is used in this setting as a routine diagnostic test. Thus, referring every patient with reflux symptoms for endoscopy is not justifiable, given the substantial cost coupled with the poor sensitivity.
Historically, subspecialists have often depended on objective diagnostic tests in the initial management of disease processes (ie, gastroenterologists would use a test such as endoscopy to diagnose gastroesophageal reflux disease [GERD]), whereas primary care physicians (PCPs) have often relied on clinical findings or the results of trials of empirical therapy to make a disease diagnosis. This disparity in initial clinical approach in GERD management between specialist gastroenterologists and PCPs is now especially questionable, given that community-based studies have shown that 40% to 60% of patients with reflux symptoms have no objective endoscopic findings of GERD. Thus, endoscopy only has a sensitivity of approximately 50% for diagnosing GERD. It is my opinion that this relatively modest (at best) sensitivity for endoscopy as a diagnostic test for GERD is underappreciated by many PCPs referring patients with suspected GERD for this procedure as a diagnostic tool. Furthermore, the charges for upper gastrointestinal tract endoscopy and the additional hidden costs (lost productivity, wages, etc, for the patient on the day of the procedure), result in a substantial societal and healthcare system burden financially when endoscopy is used in this setting as a routine diagnostic test. Thus, referring every patient with reflux symptoms for endoscopy is not justifiable, given the substantial cost coupled with the poor sensitivity.
