Disease-specific outcomes assessment for gastroesophageal reflux disease

Although endoscopy is commonly performed in patients with GER-Sx, the benefits to patients are uncertain. Patients with complications of GERD, such as stricture and ulceration, most likely benefit from diagnostic and therapeutic endoscopy. Patients with atypical symptoms of GERD, such as atypical chest pain, chronic hoarseness, or pulmonary symptoms, may benefit from diagnostic endoscopy to establish the presence or absence of esophageal pathology. It is likely that a positive endoscopy may result in specific therapy and avert further diagnostic tests. Recent data have suggested, however, that medical trials with high-dose PPI may provide equally valuable diagnostic information in patients with atypical chest pain. For the vast majority of patients with uncomplicated GER-Sx, the benefits of endoscopy remain uncertain. Although endoscopy may be used to identify patients with Barrett's esophagus or assist with medical therapy decisions, patients may do just as well without endoscopic information. The importance of establishing benefit to patients is highlighted even more when we consider that GER-Sx represents the single most common reason for endoscopy. Despite an emphasis on practicing evidence-based medicine, much of what we commonly do is empiric and intuitive, even if it is rational. Future studies in this area should focus on patient outcomes after endoscopy to ask: Does it make a difference?.