European journal of gastroenterology & hepatology
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Although upper gastrointestinal endoscopy provides very useful information about organic diseases, such as ulcers or cancer, there are still some questions about the most cost-effective strategy to apply in gastroesophageal reflux disease (GERD). In other words, is it mandatory to perform endoscopy in all patients before starting anti-reflux therapy, or is it better to treat empirically with an antisecretory drug? There are several factors in support of an empirical approach for the management of GERD in clinical practice. Indeed, typical symptoms like heartburn or regurgitation are very specific for the diagnosis of GERD when they are dominant. ⋯ Symptom relief can also be used as an indication of healing in patients with mild or moderate esophagitis at initial endoscopy. In contrast, endoscopy is still indicated in patients with persistent or recurrent symptoms of GERD. The role of the PPI test for diagnosis of GERD should be further validated before being widely recommended.