Debate: endoscopy is unnecessary in the management of uncomplicated GERD.

The case of a 56-year-old man with recurrent retrosternal heartburn no longer relieved by antacids is discussed. Arguments for and against conducting endoscopy in this patient are presented. Initial therapy with a standard dose proton pump inhibitor, without endoscopy is the suggested treatment strategy. The main purpose of conducting an endoscopy in a patient with chronic gastrointestinal reflux is to detect the presence of Barrett's esophagus. However, data indicate that the presence of Barrett's esophagus is unrelated to symptoms and that it is not significantly associated with heartburn. Additionally, there is no certainty that survival is improved by the detection of Barrett's esophagus. Nonetheless, many clinical practice guidelines support conducting endoscopy in patients with GERD.