Madeleine Coleman, MD
New Haven, Connecticut
Ye Eun Kwak, MD1, Madeleine Coleman, MD2, Mayra Sanchez, MD3, Amir Masoud, MD4
1The University of Chicago Medicine, Chicago, IL; 2Yale New Haven Hospital, New Haven, CT; 3Yale University, New Haven, CT; 4Yale University School of Medicine, New Haven, CT
Introduction: Routine diagnostic esophagogastroduodenoscopy (EGD) is recommended for refractory gastro-esophageal reflux disease (GERD) symptoms despite lack of evidence that it impacts management or outcomes. This study aims to determine if diagnostic EGD impacts management in patients with refractory GERD compared to esophageal manometry, pH testing and intra-luminal impedance.
Methods: We performed an observational study of patients with refractory GERD who underwent EGD from 2013 to 2018 at a tertiary hospital. Among 1,213 patients with GERD, we strictly excluded patients with alarm features such as dysphagia, dyspepsia; history of gastroesophageal surgery, or EGD done for other diagnostic procedures, and identified 339 patients who underwent EGD solely for persistent reflux symptoms. We then identified those who had esophageal manometry or pH-impedance studies for further evaluation of GERD, as well as if the findings of these tests resulted in a change in management (medication change or de-escalation, referral for Nissen fundoplication, etc).
Results: Among 339 patients with refractory GERD, 80.5% of patients were taking PPIs prior to and/or at the time of EGD. The majority of patients had completely normal (163/339, 48.1%) or solely benign or incidental findings (106/339, 31.3%) on EGD. Only 10.6% of patients had esophageal manometry or pH-impedance studies for refractory reflux symptoms, of those, 6.2% followed EGD and only 7 patients had these studies after a completely normal EGD. The majority of patients undergoing manometry had normal studies or minor abnormalities (23/32, 71.8%). All patients who had been ordered for intraluminal impedance or 24hr pH testing alone could not tolerate the procedure. Six of 15 patients (40%) undergoing 24hr pH-impedance testing had findings leading to a change in management. Undergoing pH-impedance testing after EGD was associated with a change in management (OR 7.33, p=0.018). PPI use was not associated DeMeester score or with results of manometry, impedance, or pH testing.
Discussion: Most patients who underwent EGD for refractory GERD symptoms alone did not have pathological findings prompting a change in management. 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.
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Citation: Ye Eun Kwak, MD; Madeleine Coleman, MD; Mayra Sanchez, MD; Amir Masoud, MD. P0271 - ROUTINE EGD HAS MINIMAL IMPACT ON REFRACTORY GERD MANAGEMENT. Program No. P0271. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.