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Introduction to Gastroesophageal Reflux: When do I need to do an endoscopy?

        Gastroesophageal reflux (or acid reflux) is a very common and annoying issue in Taiwan. Increasingly westernized diets and lifestyles have resulted in annual increases in acid reflux prevalence in Taiwan; the current prevalence rate is about 20-30%. It is estimated that about 2% of patients will develop Barrett's esophagus (a type of pre-cancerous lesion) which increases the risk of esophageal cancer.

       According to Dr. Lin Shao Jia Chiu, physician at the Division of Family Medicine in the Heping Fuyou Branch of the Taipei City Hospital, acid reflux can be categorized into classical and non-classical forms based on the type of symptoms. There are two main types of classical symptoms: heartburn and gastric acid reflux; non-classical symptoms include non-cardiac chest pain, dysphagia, the sensation of a foreign object in the throat, nausea and extra esophageal symptoms (sustained coughing, asthma and voice change). Classical symptoms can be regulated by adjusting dietary and lifestyle habits, followed by empirical therapy and disease monitoring. However, for non-classical symptoms, it is recommended to consult a specialist physician first to eliminate other possible diagnoses.

       When is endoscopy recommended to eliminate complications and the possibility of esophageal cancer? Dr. Lin Shao Jia Chiu offers the following suggestions:

  1. Warning symptoms:
  1. Newly occurring indigestion at age 60 years or above.
  2. Evidence of gastrointestinal bleeding (Hematemesis, black stool and positive fecal occult blood).
  3. Weight loss of unknown cause.
  4. Dysphagia.
  5. Pain in swallowing.
  6. Continuous vomiting.
  7. History of gastrointestinal cancer in first-degree relatives.
  1.  Multiple risk factors of “Barrett’s esophagus”:
  1. A history of gastroesophageal reflux for at least 5~10 years (required criteria).
  2. Male.
  3. Hiatal hernia.
  4. Obesity.
  5. Severe symptoms during nighttime.
  6. Smoking.
  7. History of Barrett’s esophagus or esophageal cancer in first-degree relatives.
  1. Poor response to drug treatment