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

Blustein, Philip K; Beck, Paul L.; Meddings, Jonathan B.; Rosendaal, Guido M. A. Van; Bailey, Robert J.; Lalor, Eoin; Thomson, Abr; Verhoef, MJ; Sutherland, Lloyd R.

doi:10.1111/j.1572-0241.1998.00594.x

Cited by 44 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a large survey, almost 20% of the endoscopied patients had a normal appearing mucosa and, furthermore, no malignant lesions were found in these subjects, who most likely had had symptoms of GER for long periods of time (14). In a recent Finnish study, only 15% of the patients under 50 years of age were found to have mucosal changes in endoscopy (15).…”

Section: Discussionmentioning

confidence: 97%

The Natural Course of Gastroesophageal Reflux Disease in Children

Ashorn¹,

Ruuska²,

Karikoski³

et al. 2002

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 97%

The Natural Course of Gastroesophageal Reflux Disease in Children

Ashorn¹,

Ruuska²,

Karikoski³

et al. 2002

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…In our hospital referral area with approximately 250,000 inhabitants, 10 esophageal and 50 gastric cancers are detected yearly. In a recent study with 742 GERD patients, the prevalence of Barrett’s esophagus was 6.3%, but none had esophageal cancer [42]. Moreover, in patients aged <55 years, virtually all patients with gastric or esophageal cancer have sinister symptoms (weight loss, dysphagia, persistent vomiting) when cancer is diagnosed [43].…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal Reflux Disease: Prevalence, Clinical, Endoscopic and Histopathological Findings in 1,128 Consecutive Patients Referred for Endoscopy due to Dyspeptic and Reflux Symptoms

Voutilainen

Sipponen

Mecklin∥³

et al. 2000

Digestion

157

View full text Add to dashboard Cite

Background and Aims: Gastroesophageal reflux disease (GERD) reportedly has increased in prevalence while Helicobacter pylori infection and peptic ulcer disease have been on the decrease. The aim of the present study was to examine the prevalence of GERD as well as the clinical, endoscopic and histologic variables that associate with GERD in patients referred for endoscopy. Patients and Methods: The study population was drawn from 1,562 consecutive patients referred for endoscopy. The exclusion criteria were previous H. pylori eradication, gastric surgery, anemia and weight loss. Thus 1,128 patients were enrolled in the present study. Results: Of the 1,128 patients, 199 (18%) were referred for endoscopy due to heartburn and/or regurgitation. GERD, defined as chronic (>6 months) heartburn and/or regurgitation with or without erosive esophagitis, Barrett’s esophagus, esophageal ulcer or stricture, was detected in 248 (22%) patients. Of the 248 GERD patients, 81 (33%) had endoscopy-negative GERD, but of those aged <50 years (n = 67), 57 (85%) were endoscopy-negative. The overall incidence of GERD was 307 per 100,000 population/year and that of endoscopy-positive GERD 207/100,000/year. The positive and negative predictive values of heartburn and regurgitation for endoscopy-positive GERD were 0.37 (95% CI 0.31–0.44) and 0.90 (95% CI 0.88–0.92), respectively. Independent risk factors for GERD were male sex (OR 1.9, 95% CI 1.3–2.7), previous medication for upper gastrointestinal symptoms (OR 2.7, 95% CI 1.7–4.1), the use of nonsteroidal anti-inflammatory drugs (NSAIDs; OR 2.0, 95% CI 1.3–3.0), histologic esophagitis (OR 2.2, 95% CI 1.5–3.2) and incomplete intestinal metaplasia at the gastroesophageal junction (OR 1.7, 95% CI 1.0–3.1). Chronic gastritis was protective against GERD (OR 0.7, 95% CI 0.5–0.9). No association was observed between GERD and H. pylori infection. The risk of patients aged <50 years (n = 407) of having major lesion (Barrett’s esophagus, esophageal stricture, peptic ulcer, esophageal/gastric carcinoma) was significantly lower than that of patients aged >50 years (n = 721; OR 0.5, 95% CI 0.3–0.9, p = 0.01). Conclusions: The correlation between reflux symptoms and endoscopy-positive GERD is poor and most GERD patients aged <50 years have endoscopy-negative GERD. The use of NSAIDs is a risk factor for GERD, whereas chronic gastritis, but not H. pylori infection, may protect against GERD. Incomplete intestinal metaplasia at the gastroesophageal junction is associated with GERD.

show abstract

“…No consensus exists on its precise role or on when it is best performed. 15 16 The use of endoscopy will depend on local cost, accessibility, and timing relative to treatment. Most patients should be managed empirically, at least initially.…”

Section: When Should Patients Be Referred For Endoscopy?mentioning

confidence: 99%