highvaluecarelogo
annalsinternalmed
ACPLogo2015

Upper Endoscopy for Frequent Heartburn or GERD

When you need it—and when you don’t

<PDF Versions

People with frequent heartburn often have a procedure called an endoscopy. It uses an endoscope, a flexible tube with a light and camera at the end. The tube is put down the throat to see the inside of the esophagus, which connects the throat to the stomach.

The purpose of endoscopy is to find out if you have gastroesophageal reflux disease (GERD), or a related problem. If you have GERD, the acid in your stomach rises up into the esophagus and irritates the lining.

Usually an endoscopy is not needed. Here’s why.

It usually doesn’t lead to better treatment.
If GERD is not treated, it can damage the lining of the esophagus. Some people with GERD will develop additional changes that may turn into cancer. An increased risk for cancer of the esophagus is called Barrett’s esophagus.

However, if you have GERD, your chance of having cancer of the esophagus is very low. Only about one in 2,500 patients over age 50 get this cancer each year. Even if you have Barrett’s esophagus, the risk of cancer is still quite low. As a result, frequent endoscopies are usually not needed. And, in general, they rarely change the treatments doctors offer.

It can pose risks.
Endoscopy is usually safe, but it does have risks. It can cause bleeding or damage in the stomach or esophagus. You also have to take drugs to reduce the pain and discomfort during the procedure. These drugs can cause problems with breathing and heart rhythm.

Incorrect or unclear results can lead to more tests and treatments that are not needed and have other risks.

It can cost a lot.
An endoscopy usually costs about $1,130, plus a fee for anesthesia, according to HealthcareBlueBook. com. Even if you have health insurance, your share of the cost may be high.

So when is it a good idea?
You may need an endoscopy if:

  • You still have heartburn after using a proton pump inhibitor (PPI) for four to eight weeks. PPIs include esomeprazole (Nexium), lansoprazole (Prevacid and generic), or omeprazole (Prilosec and generic).
  • You still have a very irritated esophagus even after eight weeks of PPI treatment.
  • In addition to heartburn, you also have anemia, weight loss, or frequent vomiting, you vomit blood, or you have black or red bowel movements.
  • You often have trouble swallowing, and you have had narrowing of the esophagus in the past.
  • You are a man age 50 or older, you have had GERD symptoms for more than five years, and you have other risk factors, such as smoking or being obese.

If you have Barrett’s esophagus, you will need an endoscopy once every three to five years.

If you have early signs of cancer, you will need an endoscopy more often.

11/2012

Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2012 Consumer Reports. Developed in cooperation with the American College of Physicians. To learn more about the sources used in this report and terms and conditions of use, visit ConsumerHealthChoices.org/about-us/.