Gastroesophageal reflux disease (GERD) is a common digestive condition where stomach contents persistently flow back into the esophagus, leading to symptoms or complications. This chronic acid reflux impacts about 20% of adults in the United States. An endoscopy uses a thin, flexible tube with a camera to visually examine the upper digestive tract, including the esophagus, stomach, and beginning of the small intestine. This procedure plays a key role in managing GERD.
Understanding Endoscopy for GERD
An endoscopy is recommended for evaluating GERD to confirm diagnosis and assess for complications. During the procedure, a doctor can visualize the lining of the esophagus to determine the severity of esophagitis, which is inflammation caused by stomach acid irritation.
The procedure also identifies more serious complications. These include esophageal strictures, which are narrowings of the esophagus due to scar tissue formation from chronic acid exposure. Ulcers, or open sores in the esophageal lining, can also be detected. A primary reason for endoscopy is to check for precancerous changes, such as Barrett’s esophagus.
Barrett’s esophagus involves normal esophageal cells being replaced by intestinal-like cells due to long-term acid reflux. While a risk factor for esophageal cancer, the chance of progression is low. During endoscopy, tissue samples, known as biopsies, can be collected for laboratory analysis to identify these cellular changes. The endoscope can also be used to perform treatments, such as stretching strictures.
Factors Guiding Endoscopy Frequency
Endoscopy frequency for GERD varies based on individual factors and findings. An initial endoscopy is recommended for “alarm symptoms” like difficulty swallowing, unexplained weight loss, gastrointestinal bleeding, anemia, or recurrent vomiting.
It may also be considered if GERD symptoms persist despite 4-8 weeks of twice-daily proton pump inhibitor (PPI) medication. For men over 50 with chronic GERD symptoms (over five years) and risk factors (nocturnal reflux, hiatal hernia, elevated BMI, tobacco use), a screening endoscopy may be suggested for Barrett’s esophagus.
If Barrett’s esophagus is identified, repeat endoscopies are important for surveillance of abnormal tissue changes (dysplasia). For individuals with non-dysplastic Barrett’s esophagus, guidelines suggest surveillance endoscopies every three to five years. If low-grade dysplasia is found, more frequent checks, every six to twelve months, may be recommended, along with consideration for endoscopic eradication therapy. High-grade dysplasia warrants more frequent surveillance and endoscopic ablative therapy.
Additionally, a follow-up endoscopy after eight weeks of PPI therapy is recommended for severe esophagitis to ensure healing and to check for underlying Barrett’s esophagus. Repeat endoscopies with dilation may be necessary if esophageal strictures cause recurrent symptoms.
When Repeat Endoscopies Are Not Typically Needed
Frequent or repeat endoscopies are not routinely necessary for many people with GERD. This includes individuals whose typical GERD symptoms, such as heartburn and regurgitation, respond well to prescribed medications or lifestyle adjustments. When symptoms are effectively managed and there are no concerning signs, ongoing invasive procedures are often avoided.
Repeat endoscopies are also not recommended for patients without “alarm symptoms.” The absence of difficulty swallowing, unexplained weight loss, or bleeding suggests a lower likelihood of serious complications. Furthermore, if an initial endoscopy showed no significant findings, such as Barrett’s esophagus or severe esophageal damage, and symptoms remain controlled, routine follow-up endoscopies are not indicated. The development of Barrett’s esophagus after an initially negative endoscopy is uncommon. Medical management and symptom control without ongoing endoscopic surveillance are appropriate for routine GERD care.