Endoscopy 1999; 31(8): 596-603
DOI: 10.1055/s-1999-63
Special Topic
Georg Thieme Verlag Stuttgart ·New York

2. Appropriateness of Gastroscopy: Gastro-Esophageal Reflux Disease [1]

M. Bochud *, J.-J. Gonvers **, J.-P. Vader *, R. W. Dubois ***, B. Burnand *, F. Froehlich **
  • * Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
  • ** Policlinique Médicale Universitaire, Lausanne, Switzerland
  • *** Protocare Sciences, Santa Monica, USA
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Publikationsverlauf

Publikationsdatum:
31. Dezember 1999 (online)

Introduction

Gastroesophageal reflux disease (GERD) is a very common disease in the Western world. Its symptoms and complications are a frequent reason for seeking care. GERD has been extensively studied over the last few years because of its impact on patients' quality-of-life and because of the advent of proton pump inhibitors which provide an effective medical therapy for the majority of patients regardless of disease severity at onset.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article is divided into three parts: 1. The review of the literature that was used by the panelists as the document to support their ratings of appropriateness of use of upper GI endoscopy in patients with gastroesophageal reflux disease; 2. An overview of the main panel results; 3. A summary of the published evidence and of the panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

References

  • 1 Vader J P, Burnand B, Froehlich F, et al. The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE): Project and methods.  Endoscopy. 1999;  31 572-578
  • 2 Vader J P, Froehlich F, Dubois R W, et al. The European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE): Conclusions and WWW site.  Endoscopy. 1999;  31 687-694
  • 3 Kahrilas P J. Gastroesophageal reflux disease.  J Am Med Ass. 1996;  276 983-988
  • 4 Pope C E. Acid-reflux disorders.  N Engl J Med. 1994;  331 656-660
  • 5 Wienbeck M, Barnert J. Epidemiology of reflux disease and reflux esophagitis.  Scand J Gastroenterol Suppl. 1989;  156 7-13
  • 6 Corder A P, Jones R H, Sadler G H, et al. Heartburn, oesophagitis and Barrett's oesophagus in self-medicating patients in general practice.  Brit J Clin Pract. 1996;  50 245-248
  • 7 Tibbling L. Epidemiology of gastro-esophageal reflux disease.  Scan J Gastroenterol. 1984;  19 14
  • 8 Loof L, Gotell P, Elfberg B. The incidence of reflux oesophagitis. A study of endoscopy reports from a defined catchment area in Sweden.  Scan J Gastroenterol. 1993;  28 113-118
  • 9 Ellis K K, Oehlke M, Helfand M, Liebermann D. Management of symptoms of gastroesophageal reflux disease: does endoscopy influence medical management?.  Am J Gastroenterol. 1997;  92 1472-1474
  • 10 Lieberman D A, Oehlke M, Helfand M. Risk factors for Barrett's esophagus in community-based practice. GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy.  Am J Gastroenterol. 1997;  92 1293-1297
  • 11 Werdmuller B FM, Van der Putten A BMM, Loffeld R JLF. The presentation of reflux esophagitis, hiatal hernia, Barrett's esophagus and reflux-like dypsepsia: A prospective clinical and endoscopic study.  Dis Esophagus. 1996;  9 285-289
  • 12 McDougall N I, Johnston B T, Kee F, et al. Natural history of reflux oesophagitis: a 10 year follow up of its effect on patients symptomatology and quality of life.  Gut. 1996;  38 481-486
  • 13 Shi G, Bruley des Varannes S, Scarpignato C, et al. Reflux related symptoms in patients with normal oesophageal exposure to acid.  Gut. 1995;  37 457-464
  • 14 DeVault K R, Castell D O. Guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Practice Parameters Committee of the American College of Gastroenterology.  Arch Intern Med. 1995;  155 2165-2173
  • 15 Conio M. Endoscopic features of Barrett's esophagus. G.O.S.P.E. Gruppo Operativo per lo Studio delle Precancerosi Esofagee.  Endoscopy. 1993;  25 642-644
  • 16 Fennerty M B, Castell D, Fendrick A M, et al. The diagnosis and treatment of gastroesophageal reflux disease in a managed care environment, Suggested disease management guidelines.  Arch Intern Med. 1996;  156 477-484
  • 17 Dakkak M, Hoare R C, Maslin S C, Bennett J R. Oesophagitis is as important as oesophageal stricture diameter in determining dysphagia.  Gut. 1993;  34 152-155
  • 18 Csendes A, Maluenda F, Braghetto I, et al. Location of the lower oesophageal sphincter and the squamous columnar mucosal junction in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis.  Gut. 1993;  34 21-27
  • 19 Triadafilopoulos G, Sharma R. Features of symptomatic gastroesophageal reflux disease in elderly patients.  Am J Gastroenterol. 1997;  92 2007-2011
  • 20 Johnsson F, Joelsson B, Gudmundsson K, Greiff L. Symptoms and endoscopic findings in the diagnosis of gastroesophageal reflux disease.  Scand J Gastroenterol. 1987;  22 714-718
  • 21 Smout A J. Gastro-oesophageal reflux disease in The Netherlands. Results of a multicentre pH study.  Scand J Gastroenterol. 1996;  218 (Suppl.) 10-15
  • 22 Dimenas E, Glise H, Hallerback B, et al. Quality of life in patients with upper gastrointestinal symptoms. An improved evaluation of treatment regimens?.  Scan J Gastroenterol. 1993;  28 681-687
  • 23 Zhu H, Pace F, Sangaletti O, Bianchi P G. Features of symptomatic gastroesophageal reflux in elderly patients.  Scand J Gastroenterol. 1993;  28 235-238
  • 24 Beck I T, Champion M C, Lemire S, Thomson A BR. The second Canadian consensus conference on the management of patients with gastroesophageal reflux disease.  Can J Gastroenterol. 1997;  11 7-20B
  • 25 Anonymous. The role of endoscopy in the management of esophagitis. Guidelines for clinical application.  Gastrointest Endosc. 1988;  34 9S
  • 26 Schlesinger P K, Donahue P E, Schmid B, Layden T J. Limitations of 24-hour intraesophageal pH monitoring in the hospital setting.  Gastroenterology. 1985;  89 797-804
  • 27 Smith P M, Kerr G D, Cockel R, et al. A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group.  Gastroenterology. 1994;  107 1312-1318
  • 28 Hillman A L, Bloom B S, Fendrick A M, Schwartz J S. Cost and quality effects of alternative treatments for persistent gastroesophageal reflux disease.  Arch Intern Med. 1992;  152 1467-1472
  • 29 Canadian Coordinating Office for Health Technology Assessment. Technology Overview: pharmaceutical management of gastroesophageal reflux disease. Based on “Cost-effectiveness of alternative therapies for the long-term management of gastroesophageal reflux disease”. by: O'Brien B, Goeree R, Wilkinson J, Levine M, Willan A (eds). CCOHTA Technological Overview.  http://www.ccohta.ca/pubs/english/gastro_reflux/intro.htm; 1996
  • 30 Tytgat G NJ, Janssens J, Reynolds J C, et al. Update on the pathophysiology and management of gastrooesophageal reflux disease: the role of prokinetic therapy.  Eur J Gastroenterol Hepatol. 1996;  8 603-611
  • 31 Watson D I, Foreman D, Devitt P G, Jamieson G G. Preoperative endoscopic grading of esophagitis versus outcome after laparoscopic Nissen fundoplication.  Am J Gastroenterol. 1997;  92 222-225
  • 32 Spechler S J. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disesase in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group (see comments).  N Engl J Med. 1992;  326 786-792
  • 33 Lundell L. Omeprazole or antireflux surgery in the long term management of gastroesophageal reflux disease (GERD): results of a multicentre, randomised clinical trial (Abstract).  Gastroenterology. 1998;  114 A207
  • 34 Heudebert G R, Marks R, Wilcox C M, Centor R M. Choice of long-term strategy for the management of patients with severe esophagitis - a cost-utility analysis.  Gastroenterology. 1997;  112 1078-1086
  • 35 Luostarinen M. Nissen fundoplication for reflux esophagitis. Long-term clinical and endoscopic results in 109 of 127 consecutive patients.  Ann Surg. 1993;  21 329-337
  • 36 Wo J M, Trus T L, Richardson W S, et al. Evaluation and management of postfundoplication dysphagia.  Am J Gastroenterol. 1996;  91 2318-2322
  • 37 Harris R A, Kuppermann M, Richter J E. Prevention of recurrences of erosive reflux esophagitis: A cost-effectiveness analysis of maintenance proton pump inhibition.  Am J Med. 1997;  102 78-88
  • 38 Kuipers E J, Lundell L, Klinkenberg-Knol E C, et al. Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication.  N Engl J Med. 1996;  334 1018-1022
  • 39 Varanasi R V. Protective role of Helicobacter pylori infection in gastroesophageal reflux disease (Abstract).  Gastroenterology. 1998;  114 A322
  • 40 Wu J CY. Prevalence and distribution of H. pylori in gastroesophageal reflux disease: a study in Chinese (Abstract).  Gastroenterology. 1998;  114 A334
  • 41 Vicari J J. CAG A positivity may be protective against more severe grades of esophagitis (Abstract).  Gastroenterology. 1998;  114 A324
  • 42 Friedman G. Is Helicobacter pylori eradication associated with the endoscopic development of esophagitis? (Abstract).  Gastroenterology. 1998;  114 A124
  • 43 Di Mario F. The appearance of GORD in patients with duodenal ulcer after eradication of Helicobacter pylori infection: a 4 year prospective study. (Abstract).  Gastroenterology. 1998;  114 A105
  • 44 Koike T. Increase of gastric acid secretion after H. pylori eradication caused the development of reflux esophagitis. (Abstract).  Gastroenterology. 1998;  114 A183
  • 45 Holtmann G. The impact of H. pylori on healing of reflux esophagitis during treatment with pantoprazole (Abstract).  Gastroenterology. 1998;  114 A151
  • 46 Talley N J. No increase of reflux symptoms or esophagitis in patients with non-ulcer dyspepsia 12 months after Helicobacter pylori eradication. A randomized double-blind placebo-controlled trial (Abstract).  Gastroenterology. 1998;  114 A306
  • 47 Malfertheiner P. Does cure of Helicobacter pylori infection induce heartburn? (Abstract).  Gastroenterology. 1998;  114 A212
  • 48 Bytzer P. Eradication of H. pylori or long-term acid suppression in duodenal ulcer: a double-blind randomized trial with a two-year follow-up (Abstract).  Gastroenterology. 1998;  114 A83
  • 49 Peters F TM. Helicobacter pylori and esophageal acid exposure in GERD (Abstract).  Gastroenterology. 1998;  114 A257
  • 50 Leodolter A. Impact of Helicobacter pylori infection on gastroesophageal reflux (Abstract).  Gastroenterology. 1998;  114 A200
  • 51 Vignieri S, Termini R, Leandro G, et al. A comparison of five maintenance therapies for reflux esophagitis.  N Engl J Med. 1995;  333 1106-1110
  • 52 Fennerty M B. Barrett's esophagus: what do we really know about this disease?.  Am J Gastroenterol. 1997;  92 1-3
  • 53 Eisen G M, Sandler R S, Murray S, Gottfried M. The relationship between gastroesophageal reflux disease and its complications with Barrett's esophagus.  Am J Gastroenterol. 1997;  92 27-31
  • 54 Cameron A J, Lomboy C T. Barrett's esophagus: age, prevalence, and extent of columnar epithelium (see comments).  Gastroenterology. 1992;  103 1241-1245
  • 55 De Bosset V, Gonvers J J, Froehlich F, et al. Appropriateness of gastroscopy: Bleeding and dysphagia.  Endoscopy. 1999;  31 615-622
  • 56 Ollyo J B, Fontolliet C, Brossard E, et al. La nouvelle classification de Savary des oesophagites de reflux.  Acta Endoscopia. 1992;  22 307-320
  • 57 Bochud M, Gonvers J J, Vader J P, et al. Appropriateness of gastroscopy: Barrett's esophagus.  Endoscopy. 1999;  31 604-610

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

Prof. Jean-Jacques Gonvers

Policlinique Médicale Universitaire

Rue César-Roux 19

CH -1005 Lausanne

Switzerland

Telefon: + 41-21-3452323

eMail: Jean-Jacques.Gonvers@inst.hospvd.ch

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