The utility of endoscopy in the management of patients with gastroesophageal reflux symptoms

Objective: The utility of endoscopy in the management of patients with symp toms of gastroesophageal reflux disease (GERD) is unclear. The purpose of t his prospective study was to assess the impact of endoscopy on the subseque nt management of patients with uncomplicated reflux symptoms. Methods: A to tal of 742 patients underwent endoscopy for symptoms of GERD. Endoscopists recorded the therapy before endoscopy, the findings of endoscopy, and the t reatment recommendations after endoscopy. Results: There was no difference in pre-endoscopy therapy or grade of esophagitis in subjects undergoing end oscopy for failed therapy versus GERD symptoms alone. After endoscopy, the most common strategy for patients taking omeprazole was to maintain or incr ease the dose. For those taking an H-2 blocker before endoscopy, the most c ommon outcome was to switch the patient to omeprazole, independent of the g rade of esophagitis. Conclusions: Most patients undergoing endoscopy for sy mptoms of GERD were switched to omeprazole regardless of the endoscopic fin dings. No esophageal cancer was identified and the incidence of Barrett's e sophagus was low. It appears that endoscopy itself did not change the manag ement of patients receiving H-2-blocker therapy. A trial of a proton pump i nhibitor before endoscopy should he considered. (C) 1998 by Am. Cell. of Ga stroenterology.