Indications for Endoscopy in GERD

The is no agreed upon consensus on indication or contra-indications for performing endoscopy in patients with GERD.  However, based on my clinical experience and recommendations from the ACG and ASGE, I use the following guidelines in my practice.  Of course, individual cases may merit performance of endoscopy in patients who would not fall within these general guidelines. 

• Dysphagia to solids
• Weight loss and anorexia
•  Iron deficiency anemia and occult G.I. blood loss
• Elderly patients with GERD symptoms
• White males 40 years or older with heartburn (increased risk of Barrett’s esophagus)
• Surveillance of Barrett’s patients to look for dysplasia and cancer
• Patients with extra-esophageal manifestations of GERD (to possibly confirm GERD diagnosis by finding erosive esophagitis)
• Patients with severe heartburn not responding to appropriate medical management.