Do I Need Another Endoscopy?

Question
I underwent an endoscopic exam about 1 year ago and was diagnosed with gastroesophageal reflux disease (GERD). Do I need another endoscopy? How can I tell if there has been damage to the esophagus?
Answer

This is a very common question in my practice. It is important for someone with chronic heartburn symptoms to have an endoscopy. The most important thing to look for is Barrett’s esophagus, a change in the lining of the esophagus that is associated with an increased cancer risk. The endoscopist will also be looking for esophagitis, damage to the lining of the esophagus. The endoscopist may see a hiatal hernia or other anatomic abnormalities.

Patients with Barrett’s esophagus should be enrolled in a surveillance program to look for signs of abnormal tissue (dysplasia) or cancer. This is a very slow growing cancer and endoscopies are usually done every 3 years. Patients with esophagitis should have a repeat endoscopy to demonstrate healing. Occasionally, when the esophagitis is healed, one can see Barrett’s esophagus.

Patients with no esophagitis and no Barrett’s esophagus on their initial endoscopy should not need a repeat exam unless there has been a major change in symptoms. The reason is that if heartburn symptoms are well controlled, it is uncommon to develop Barrett’s esophagus.

More importantly, it is extremely uncommon to develop Barrett’s esophagus and then develop esophageal cancer. If there is no history of esophagitis and your heartburn is controlled with your diet and medications, you can be fairly certain that there is no significant ongoing esophageal injury.

– J. Patrick Waring, MD

Adapted from IFFGD Publication: Do I Need Another Endoscopy? by J. Patrick Waring, MD, Digestive Healthcare of Georgia, Atlanta, GA.

Published in Digestive Health Matters, Vol. 18, No. 1.