GERD Indications for Endoscopy

[futuredoctor10]

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So I know the classic indications for endoscopy in GERD patients (dysphagia, odynophagia, weight loss, anemia or GI bleed). And of course if someone has had years of GERD you want to check for Barrett's.

But let's say someone comes in with GERD symptoms and you start a PPI trial. Their symptoms still persist. How long do you wait before doing an endoscopy?

Clinically I know this is a judgment call. I have read endoscopy is indicated when GERD symptoms persist for >5 years. I've also read if symptoms do not resolve after therapeutic PPI is used for 4-8 weeks, to get endoscopy.

Just curious what to learn for 2CK. I am thinking they will ask in a way that is more clear: if new-onset symptoms > try a PPI. If symptoms have persisted despite PPI > endoscopy.

 

[evilbooyaa]

If they have just GERD without ulcer sx (worsened/better with eating) I don't know that your next step would be an EGD. I think it's a clinical grey area, and something that step 2 would not ask you to differentiate. However, if someone comes in with refractory GERD (again, without evidence of PUD), I don't know that I would be able to not go with "Endoscopy" as the answer choice, as the person could have had subclinical GERD for years prior to it becoming symptomatic.

 

[Rostam]

If after 4-8 weeks of PPI Tx, GERD persists, the next step is 24-h pH monitoring to demonstrate whether really the patient has GERD or not. Ref: Dr. Conrad Fischer

 

[futuredoctor10]

If after 4-8 weeks of PPI Tx, GERD persists, the next step is 24-h pH monitoring to demonstrate whether really the patient has GERD or not. Ref: Dr. Conrad Fischer

Oo that makes sense. And if that is not an answer choice, then pick endoscopy.