Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Treat or investigate?

J P Galmiche1

  • 1Hôpital Hôtel Dieu, Service Hépato-gastro-entérologie, Nantes, France.

European Journal of Gastroenterology & Hepatology
|August 12, 1999
PubMed
Summary
This summary is machine-generated.

For most gastroesophageal reflux disease (GERD) patients, a symptom-based approach with proton pump inhibitors (PPIs) is effective. Endoscopy is reserved for those with persistent or alarm symptoms, ensuring cost-effective management.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

Editorial: the diminishing returns of normalisation of the oesophageal mucosa-Authors' reply.

Alimentary pharmacology & therapeutics·2017
Same author

The dynamics of the oesophageal squamous epithelium 'normalisation' process in patients with gastro-oesophageal reflux disease treated with long-term acid suppression or anti-reflux surgery.

Alimentary pharmacology & therapeutics·2017
Same author

Long-term safety of proton pump inhibitor therapy assessed under controlled, randomised clinical trial conditions: data from the SOPRAN and LOTUS studies.

Alimentary pharmacology & therapeutics·2015
Same author

Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

Endoscopy·2012
Same author

Colonic mucosal biopsies obtained during confocal endomicroscopy are pre-stained with fluorescein in vivo and are suitable for histologic evaluation.

Endoscopy·2012
Same author

Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer.

Alimentary pharmacology & therapeutics·2010
Same journal

Comment on 'Associations between 12 insulin resistance surrogates with metabolic dysfunction-associated steatotic liver disease risk and all-cause mortality: data from the National Health and Nutrition Examination Survey III (1988-1994)'.

European journal of gastroenterology & hepatology·2026
Same journal

Alarm symptoms at diagnosis of coeliac disease and long-term outcomes.

European journal of gastroenterology & hepatology·2026
Same journal

Artificial intelligence-integrated nanotherapeutics for rare Peutz-Jeghers syndrome hamartoma-induced obstructions: latest clearance strategies.

European journal of gastroenterology & hepatology·2026
Same journal

'Presence of alarm symptoms at coeliac disease diagnosis is not associated with poorer long-term treatment outcomes' [Letter].

European journal of gastroenterology & hepatology·2026
Same journal

Atrial fibrillation in patients with alcohol-associated hepatitis leads to increased mortality.

European journal of gastroenterology & hepatology·2026
Same journal

Association between albumin-bilirubin score, model for end-stage liver disease score, platelet-albumin-bilirubin score, and acute-on-chronic liver failure complications: a cross-sectional study in a Chinese population.

European journal of gastroenterology & hepatology·2026
See all related articles

Area of Science:

  • Gastroenterology
  • Clinical Practice Guidelines
  • Health Economics

Background:

  • Upper gastrointestinal endoscopy is valuable for diagnosing organic diseases but its routine use in gastroesophageal reflux disease (GERD) is debated.
  • Typical GERD symptoms like heartburn and regurgitation are prevalent but not always indicative of significant pathology.
  • The low prevalence of esophagitis and high rate of negative endoscopy findings question the cost-effectiveness of universal endoscopic evaluation.

Purpose of the Study:

  • To evaluate the most cost-effective strategy for managing gastroesophageal reflux disease (GERD).
  • To determine if empirical treatment with antisecretory drugs is preferable to routine endoscopy in all GERD patients.
  • To identify criteria for selecting patients who would benefit most from endoscopy versus empirical therapy.

Related Experiment Videos

Main Methods:

  • Review of clinical practice factors supporting an empirical approach for GERD management.
  • Analysis of symptom specificity, prevalence of esophagitis, and outcomes of mild-to-moderate lesions.
  • Consideration of patient quality of life, potential for masking organic diseases, and cost-effectiveness of different strategies.

Main Results:

  • A symptom-based strategy is practical and feasible for the majority of primary care GERD patients.
  • Empirical treatment with proton pump inhibitors (PPIs) can be safely prescribed following simple guidelines for typical GERD symptoms in younger patients without alarm signs.
  • Endoscopy is indicated for persistent or recurrent GERD symptoms, or when alarm symptoms are present.

Conclusions:

  • A symptom-based approach, often involving empirical proton pump inhibitor (PPI) therapy, is a practical and cost-effective strategy for most GERD patients in primary care.
  • Endoscopy remains crucial for patients with persistent symptoms, alarm features, or when empirical treatment fails.
  • Further validation of the PPI test for GERD diagnosis is warranted before widespread recommendation.