Introduction For gastro-esophageal reflux (GORD), upper endoscopy may be indicated in older men with chronic GORD symptoms (greater than 5 years) and additional risk factors such as elevated body mass index and tobacco use, to increase detection of Barretts oesophagus and esophageal adenocarcinoma.
Upper endoscopy is indicated in patients with GORD and alarm symptoms such as dysphagia, weight loss, bleeding, anaemia and recurrent vomiting. Without alarm symptoms upper endoscopy is only indicated when symptoms of GORD persist or progress despite appropriate medical therapy.
Inappropriate use of upper endoscopy does not improve the health of patients, exposes them to preventable harms, can lead to unnecessary interventions and result in unnecessary costs with no benefit.
Our aim was to assess the findings at upper endoscopy performed in patients under the age of 50 presenting with GERD without alarm symptoms.
Methods A single centre, retrospective analysis in a large London NHS Foundation Hospital was performed. All patients endoscoped for reflux were identified using Unisoft Endoscopy reporting software across a period of 10 years (June 2005-May2015). Data from the patients’ electronic records was reviewed for histological diagnosis of Barrett’s or cancer.
Results 124 of the 1772 patients endoscoped for reflux symptoms alone were found to have Barrett’s (7%).
627 of the 1772 patients were under the age of 50 at time of endoscopy Out of the patients under the age of 50, 23 (3.6%) were identified as having Barrett’s at the time of endoscopy but histologically proven in only 13 (2%) the others were shown to have reflux oesophagitis only. No patients were found to have cancer of the oesophagus or stomach.
Out of the 13 patients with proven Barrett’s 4 patients had a length longer than 3 cm with a maximum length of 6 cm. All other patients had short segments of Barrett’s (less than 3 cm) and none had evidence of dysphasia or malignancy.
Conclusion The role of endoscopy in patients under the age of 50 with symptoms of GORD only would appear to be an inappropriate first line investigation. In our case series only 2% patients endoscoped under the age of 50 were identified a histological positive diagnosis of Barrett’s. Inview of current guidelines only 0.3% would require surveillance endoscopy but this in itself remains questionable.
Disclosure of Interest None Declared
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