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Endoscopy 2006; 38(3): 271-275
DOI: 10.1055/s-2006-924971
Review
© Georg Thieme Verlag KG Stuttgart · New York

Pretreatment Endoscopy - Pro & Contra: Endoscopy Is Needed before Treatment in All Patients with Gastroesophageal Reflux Disease

F.  Pace1 , G.  Manes1 , M.  Conio2 , G.  Bianchi Porro1
  • 1Dept. of Gastroenterology, L. Sacco University Hospital, Milan, Italy
  • 2Endoscopy Unit, Sanremo General Hospital, Sanremo, Italy
Further Information

Publication History

Submitted 2 April 2005

Accepted after revision 8 August 2005

Publication Date:
10 March 2006 (online)

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Most current endoscopic guidelines do not recommend the use of routine esophagoscopy in the evaluation of patients with typical symptoms of gastroesophageal reflux disease (GERD), unless alarm features are present. In patients with known reflux esophagitis, esophagoscopy is considered to have no role either in the further management or follow-up. Screening of reflux patients for Barrett’s esophagus is not considered to be cost-effective. On the basis of a critical review of the available literature, and of some recent papers in particular, we disagree with these suggestions.
We would argue, on the contrary, that a negative esophagoscopy can provide the GERD patient with reassurance, and that esophagoscopy allows targeted therapy to be offered if it is positive for esophagitis. When Barrett’s esophagus is diagnosed, it usually leads to a surveillance program being initiated. The potential benefits of endoscopy for the patient’s quality of life are probably underestimated when financial issues alone are taken into account. Even if it is true that a large percentage of GERD patients do not have endoscopic abnormalities (those with nonerosive reflux disease), surrogate tests such as the proton-pump inhibitor test or symptom questionnaires do not provide a more accurate diagnosis.
We would therefore suggest that, at least in the specialist setting, all patients with suspected GERD should undergo accurate symptom analysis as well as endoscopic evaluation before treatment is started.

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F. Pace, M. D.

Dept. of Gastroenterology · L. Sacco University Hospital

Via G. B. Grassi, 74 · 20157 Milan · Italy

Fax: +39-02-3562591

Email: cn.fapac@tin.it

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