2. Appropriateness of Gastroscopy: Gastro-Esophageal Reflux Disease [1]

Introduction

Gastroesophageal reflux disease (GERD) is a very common disease in the Western world. Its symptoms and complications are a frequent reason for seeking care. GERD has been extensively studied over the last few years because of its impact on patients' quality-of-life and because of the advent of proton pump inhibitors which provide an effective medical therapy for the majority of patients regardless of disease severity at onset.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RAND appropriateness method, including the literature search process [1], and of the whole process, as well as the global results of the panel [2], are published as separate articles in this issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article is divided into three parts: 1. The review of the literature that was used by the panelists as the document to support their ratings of appropriateness of use of upper GI endoscopy in patients with gastroesophageal reflux disease; 2. An overview of the main panel results; 3. A summary of the published evidence and of the panel-based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)