MANAGEMENT OF SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE - DOES ENDOSCOPY INFLUENCE MEDICAL-MANAGEMENT

Objectives: The purpose of this study was to examine the theories that underlie the clinical decision to perform endoscopy in patients with symptoms of gastroesophageal reflux disease (GERD). Physicians reporte d that they use endoscopic findings to modify medical treatment of GER D. This study was undertaken to test this hypothesis in clinical pract ice. Methods: A consortium of community specialists in gastrointestina l disease was formed. Physicians completed a database on patients unde rgoing elective endoscopy for symptoms of GERD, which includes symptom severity, endoscopic findings, and medical treatment before and after endoscopy. An increase in medical treatment was defined as an increas e in acid suppression therapy, and/or the addition of a promotility dr ug, and/or referral for surgery. Results: Data were collected prospect ively over 6 months on 664 patients with symptoms of GERD, and complet e data were available on 598 patients. Barrett's esophagus or active e sophagitis (erythema, erosions, or ulceration) was present in 374 pati ents. Of these patients, 74% had an increase in therapy after endoscop y; for only 5% did therapy decrease. In contrast, among 224 patients w ith a normal-appearing esophagus, 35% had an increase in treatment and 65% had either a decrease in treatment or no change. In most cases, t he increase in treatment was due to persistence of symptoms or because of endoscopic findings in the stomach or duodenum. The differences in treatment changes between the two groups was highly significant (p < 0.0001). Conclusion: The results support the theory that physicians of ten use endoscopic results to tailor medical therapy in patients with symptoms of GERD.