The American College of Gastroenterology recently published a clinical practice guideline for the evaluation and treatment of gastroesophageal reflux disease (GERD).^[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56. The new guideline provides updated, evidence-based recommendations, addressing lifestyle changes, appropriate use of proton pump inhibitors (PPIs), the role of objective testing, and surgical options.

As noted in the ACG guideline, gastroesophageal reflux disease (GERD) is an extremely common condition and represents one of the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. This is typically an uncomplicated and self-limited condition that presents as classic “heart burn” and can be managed with lifestyle modifications, over the counter medications such as Histamine-H2 receptor blockers, or prescription medications such as certain proton pump inhibitors (PPIs).  The current ACG guidelines emphasize that upper endoscopy rarely alters the management strategy of uncomplicated GERD and highlights that PPIs are highly effective at treating symptoms and healing the erosive consequences that can result from GERD.  Symptoms that do not resolve after an 8-week trial of empiric PPIs or that suggest complications from GERD or alternate diagnoses such as dysphagia, weight loss, or bleeding are considered appropriate indications for endoscopy as they may require endoscopic treatment or reveal time-sensitive diagnoses such as strictures, dysplasia, or masses.

At Carelon, our current medical necessity review of upper endoscopies aligns with the ACG’s most recent recommendations to pursue an 8-week course of empiric treatment for uncomplicated GERD and reserve upper endoscopy for patients who fail this initial treatment strategy or who present with alarm symptoms. As noted in the ACG guidelines, a normal mucosa is the most common endoscopic finding in patients with typical GERD symptoms, thus further supporting a treatment-first strategy and avoidance of unnecessary upper endoscopy in this large, low-risk population.

Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27-56.