Gastroesophageal reflux disease (GERD) is among the most common conditions encountered in primary care practice. Its effect on quality of life is substantial. Upper endoscopy is widely available and routinely done for diagnosis and management of GERD and its complications. However, the indications for this procedure are incompletely defined. Overuse of upper endoscopy contributes to higher health care costs without improving patient outcomes. The purpose of this best practice advice article from the Clinical Guidelines Committee of the American College of Physicians (ACP) is to describe the indications for, and yield of, upper endoscopy in the setting of GERD and to help primary care physicians make high-value decisions about referral of patients for upper endoscopy. In formulating these recommendations, a team of general internists, gastroenterologists, and clinical epidemiologists reviewed the literature on use of upper endoscopy in the setting of GERD, as well as epidemiology of GERD and esophageal adenocarcinoma. Clinical guidelines from professional organizations recommending use of upper endoscopy in GERD were compared. This document is not based on a formal systematic review but instead seeks to provide practical advice based on the best available evidence.
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