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Test and treat or treat and test in reflux disease?
Author(s) -
Vakil N.
Publication year - 2003
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.17.s2.7.x
Subject(s) - medicine , reflux , dysphagia , disease , gerd , endoscopy , gold standard (test) , esophageal disease , proton pump inhibitor , gastroenterology , diagnostic test , test (biology) , intensive care medicine , surgery , esophagus , pediatrics , paleontology , biology
Summary The role of diagnostic testing in reflux disease is in evolution. There is little question that patients with dysphagia, bleeding or other ‘alarm’ symptoms, should undergo early endoscopy. A substantial proportion of patients presenting with reflux symptoms have endoscopy negative reflux disease. pH testing is both inconvenient and lacks the sensitivity and specificity required for a ‘gold standard’. Empirical trials of therapy using proton pump inhibitors have shown that a trial of treatment may be the most accurate way of diagnosing gastro‐oesophageal reflux disease (GERD) and may the optimal strategy from a cost‐effectiveness standpoint. On the other hand, the increasing rate of oesophageal adenocarcinoma has raised questions about the possible value of screening endoscopy to determine if Barrett's oesophagus is present. The role of endoscopic testing in the average patient is therefore shifting from a diagnostic modality to one that helps manage risk by identifying Barrett's oesophagus.