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What Happens if GERD Symptoms Persist After Endoscopy?

written by: Emma Lloyd • edited by: Leigh A. Zaykoski • updated: 9/24/2010

Endoscopy is often used in the treatment of GERD if a patient does not respond to medication, but even this surgical procedure is not guaranteed to provide relief. What does it mean if, after endoscopy, GERD symptoms persist?

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    The Endoscopy Procedure

    GERD is often diagnosed on the basis of a person’s symptoms, and on his or her response to medication. Endoscopy isn’t normally necessary, and is not recommended for treatment unless other methods of treatment fail.

    In the endoscopy procedure a long, thin, flexible tube is inserted into the patient’s throat and into the esophagus. The tube is fitted with a tiny light source and camera. The camera transmits images to a monitor so that the endoscopist can view the interior of the esophagus. The endoscopist might also take a sample of tissue from the esophagus for diagnostic tests.

    Endoscopy for GERD Diagnosis: This procedure is used in GERD diagnosis when a patient has what is called “complicated” GERD. This term means that there are other symptoms present that suggest a more serious disease than GERD might be involved. For example, if a doctor suspects a patient has GERD complicated by epigastric cancer, she is likely to refer the patient to a specialist for endoscopy.

    Endoscopy for GERD Treatment: Endoscopy is not only a diagnostic procedure; it can also be used for treatment. For example, surgery might be carried out on the lower esophageal sphincter (LES), the ring of muscle that can contribute to GERD symptoms. The most common surgery for GERD is called fundoplication. In this procedure, part of the stomach is wrapped around the LES to strengthen it and prevent GERD symptoms.

    So, what does it mean if you undergo this procedure and after endoscopy, GERD symptoms persist?

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    Possible Reasons for Continued GERD Symptoms

    If endoscopy is carried out for GERD diagnosis there is of course no issue if GERD symptoms continue after the procedure is over. In this case the endoscopy hasn’t been carried out to treat GERD, but another condition, so it is actually likely that symptoms will continue after the procedure.

    However, if the procedure was carried out specifically as a treatment for GERD symptoms, there is cause for alarm if symptoms persist.

    If symptoms persist it is generally because the fundoplication procedure has failed in some way. Surgical failure can occur because of physiologic abnormalities in the patient, or because the fundoplication itself has failed. For example, fundoplication failure can occur if surgical stitching of the stomach is disrupted during the recovery period, or if the stitched portion of stomach slips down over the unstitched part.

    Another possible reason why symptoms of GERD might persist is that the patient has complicated disease, where another medical condition is causing GERD-like symptoms even after endoscopy.

    When GERD symptoms persist after endoscopy, the patient is likely to undergo further diagnostic imaging tests such as x-ray or MRI scan to evaluate the cause of symptoms. He or she might also undergo further surgery to repair and strengthen the fundoplication.

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    References

    M. Brian Fennerty, MD: When Should Endoscopy Be Done in the Patient With Reflux?: Endoscopy for the Diagnosis of GERD

    National Digestive Diseases Information and Clearinghouse: Heartburn, GER, and GERD

    U.S. National Guideline Clearinghouse: Role of endoscopy in the management of GERD