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Heartburn? Skip that endoscopy, it's overused, doctors say

Published: Tuesday, Dec. 4 2012 1:03 p.m. MST

People with severe heartburn often have endoscopy to see what's going on.

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People with severe heartburn — about 40 percent of adults — often undergo endoscopy to see what's going on. But the American College of Physicians says it's usually not needed and is both expensive and can create complications.

"The evidence indicates that upper endoscopy is indicated in patients with heartburn only when accompanied by other serious symptoms such as difficult or painful swallowing, bleeding, anemia, weight loss or recurrent vomiting," said Dr. David L. Bronson, president of the college, in a written statement. "The procedure is not an appropriate first step for most patients with heartburn."

The group published its new evidence-based clinical policy paper in the Annals of Internal Medicine on Dec. 4.

MyHealthNewsDaily reported that the test might also be warranted if someone doesn't respond to treatment with medication after a couple of months.

In endoscopy, a flexible tube with camera is inserted down the throat to look at the upper digestive tract, including the esophagus and stomach. Complications are very rare, but because of the overuse, it still "implies the potential for thousands of complications," the ACP said.

The physicians' group also noted that screening with upper endoscopy might be useful in men over 50 with multiple risk factors for Barrett's esophagus, including heartburn for five or more years, nighttime reflux symptoms, hiatal hernia, being overweight, tobacco use and fat in the abdominal cavity. But if the initial screening is negative for Barrett's esophagus or esophageal cancer, follow-up screening endoscopy is not indicated.

Only a small percentage of people who have long-term gastroesophageal reflux, known as GERD, which is chronic regurgitation of acid from the stomach into the lower esophagus, will develop Barrett's, which changes the color and composition of esophageal cells. It increases the risk of developing cancer and while the risk remains small, monitoring is needed, according to the Mayo Clinic.

If Barrett's is found, screening every three to five years is appropriate. More frequent screening is reserved for patients with dysplasia, which means the tissue has started to change in ways that could be precancerous.

"Inappropriate use of upper endoscopy does not improve the health of patients, exposes them to preventable harms, may lead to additional unnecessary interventions and results in unnecessary costs with no benefit," Bronson said.

"It's an area of uncertainty if screening prevents death from cancer," guidelines author Dr. Nicholas Shaheen, director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina, told HealthDay.

HealthDay reporter Carina Storrs noted that, "Although the ACP guidelines are similar to those of organizations such as the American Gastroenterological Association, they stand apart for specifically recommending against screening women with GERD for esophageal cancer."

Their research indicates that a woman's risk of esophageal cancer with GERD is similar to that of breast cancer among men.

The physicians estimate about a third of endoscopies do not meet the new guidelines. Shaheen told HealthDay the most likely reasons are a doctor's desire to be thorough, patient expectations, financial incentives and worries about being sued.

EMAIL: lois@desnews.com, Twitter: Loisco

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