Indications for initial endoscopy in adults with reflux-like symptoms

Clinical features

Alarm symptoms suggestive of gastrointestinal malignancy

New-onset dyspepsia in patient ≥60 years old
Evidence of gastrointestinal bleeding (hematemesis, melena, hematochezia, occult blood in stool)
Iron deficiency anemia
Anorexia
Unexplained weight loss
Dysphagia
Odynophagia
Persistent vomiting
Gastrointestinal cancer in a first-degree relative

Screening for Barrett's esophagus^*

Chronic GERD (at least 5 years of persistent symptoms) plus 3 of the following additional risk factors for Barrett's esophagus^*:

Age >50 years
Male sex
Non-Hispanic white individuals
Obesity
Tobacco use (past or current)
First-degree relative with Barrett's esophagus and/or esophageal adenocarcinoma

Luminal abnormality on abdominal imaging of upper gastrointestinal tract

Upper endoscopy is indicated in individuals with these features. However, most individuals with typical reflux-like symptoms of heartburn or regurgitation do not need initial endoscopy.

GERD: gastroesophageal reflux disease.

* Professional guidelines provide different criteria for screening for Barrett's esophagus and are based predominantly on expert consensus. There is not randomized trial evidence that demonstrates a reduction in esophageal adenocarcinoma mortality with screening for Barrett's esophagus.

References:

Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: An updated ACG Guideline. Am J Gastroenterol 2022; 117:559.
Muthasmy VR, Wani S, Gyawali CP, et al. AGA clinical practice update on new technology and innovation for surveillance and screening in Barrett's esophagus: Expert review. Clin Gastroenterol Hepatol 2022; 20:2696.

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Indications for initial endoscopy in adults with reflux-like symptoms