SAN ANTONIO — In most cases of diagnostic esophagogastroduodenoscopy (EGD) performed for refractory gastro-esophageal reflux disease (GERD), symptoms alone did not result in pathological findings that prompted a change in the patient’s GERD management, according to research presented at the ACG Annual Scientific Meeting, held October 25 to 30, 2019, in San Antonio, Texas. Post-EGD pH-impedance was, however, associated with a change in GERD management and may be a better initial evaluation step for patients with symptoms of refractory GERD.

Routine diagnostic EGD is recommended for refractory GERD symptoms despite the lack of evidence that it has an impact on management or outcomes. This observational study was designed to compare the impact on management of diagnostic EGD with that of esophageal manometry, pH testing, and intra-luminal impedance. Data were taken from patients (N=339) with refractory GERD undergoing EGD at a tertiary hospital between 2013 and 2018. Patients were excluded for alarm features such as dyspepsia or dysphagia, previous EGD, and history of gastroesophageal surgery.

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Of the total 339 patients, 80.5% were taking proton pump inhibitors (PPIs) before and/or at the time of diagnostic EGD. PPI use was not associated DeMeester score or results of impedance, pH testing, or manometry. Most patients’ EGD findings were completely normal (163/339, 48.1%) or solely benign or incidental (106/339, 31.3%). Only 10.6% of total patients had esophageal manometry or pH-impedance studies, and of those who did, 6.2% did so following EGD, and only 7 had these after a normal EGD. Most patients who underwent manometry had normal studies or studies with minor abnormalities (23/32, 71.8%). None of the patients ordered for intraluminal impedance or 24-hour pH testing alone could tolerate the procedure, and 6 of 15 (40%) patients who underwent 24-hour pH impedance testing had results that led to a change in management. Undergoing pH impedance testing post-EGD was associated with a change in GERD management (OR, 7.33; P =.018).


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“Most patients who underwent EGD for refractory GERD symptoms alone did not have pathological findings prompting a change in management,” the investigators concluded. “There were no demographic variables that predicted pathologic findings on EGD. Very few patients underwent subsequent or concomitant esophageal manometry, impedance or pH testing. pH-impedance after EGD was associated with a change in management, and may be a better first step in evaluating patients with refractory GERD symptoms, than EGD.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Kwak YE, Coleman M, Sanchez M, Masoud A. Routine EGD has minimal impact on refractory GERD management. Presented at: ACG Annual Scientific Meeting; October 25-30, 2019; San Antonio, TX. Abstract #P0271