Current GERD Reports

, Volume 1, Issue 4, pp 215–219 | Cite as

Alarm symptoms of GERD

  • John M. WoEmail author


Heartburn is very common. In the United States, about 20% of adults report experiencing heartburn at least once a week. The practice guidelines for gastroesophageal reflux disease (GERD) recommend diagnostic testing in the presence of alarm symptoms, which include dysphagia, odynophagia, weight loss, gastrointestinal bleeding, and anemia. A detailed history of the pattern, severity, and duration of alarm symptoms is essential. What are the benefits of identifying alarm symptoms in patients with GERD? Does identifying patients with alarm symptoms improve the treatment outcome? The goals of this review are to define the alarm symptoms of GERD, determine their ability to predict reflux complications and upper gastrointestinal malignancy, and develop a management strategy for patients with alarm symptoms.


Gastric Cancer Esophagitis Dyspepsia Gastrointestinal Cancer Esophageal Stricture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Locke GR III, Talley NJ, Fett SL, et al.: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997, 112:1448–1456.PubMedCrossRefGoogle Scholar
  2. 2.
    Dent J, El-Serag HB, Wallander MA, Johansson S: Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005, 54:710–717.PubMedCrossRefGoogle Scholar
  3. 3.
    Rey E, Moreno-Elola-Olaso C, Rodriguez-Artalejo F, Diaz-Rubio M: Medical consultation for gastro-oesophageal reflux symptoms: reasons and associated factors. Digestion 2004, 70:173–177.PubMedCrossRefGoogle Scholar
  4. 4.
    DeVault KR, Castell DO: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 1999, 94:1434–1442.PubMedCrossRefGoogle Scholar
  5. 5.
    Moraes-Filho J, Cecconello I, Gama-Rodrigues J, et al.: Brazilian consensus on gastroesophageal reflux disease: proposals for assessment, classification, and management. Am J Gastroenterol 2002, 97:241–248.PubMedCrossRefGoogle Scholar
  6. 6.
    Armstrong D, Marshall JK, Chiba N, et al.: Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults—update 2004. Can J Gastroenterol 2005, 19:15–35.PubMedGoogle Scholar
  7. 7.
    Fock KM, Talley N, Hunt R, et al.: Report of the Asia-Pacific consensus on the management of gastroesophageal reflux disease. J Gastroenterol Hepatol 2004, 19:357–367.PubMedCrossRefGoogle Scholar
  8. 8.
    Mason JM, Delaney B, Moayyedi P, et al.: Managing dyspepsia without alarm signs in primary care: new national guidance for England and Wales. Aliment Pharmacol Ther 2005, 21:1135–1143.PubMedCrossRefGoogle Scholar
  9. 9.
    Talley NJ, Vakil N: Guidelines for the management of dyspepsia. Am J Gastroenterol 2005, 100:2324–2337.PubMedCrossRefGoogle Scholar
  10. 10.
    Eisendrath P, Tack J, Deviere J: Diagnosis of gastroesophageal reflux disease in general practice: a Belgian national survey. Endoscopy 2002, 34:998–1003.PubMedCrossRefGoogle Scholar
  11. 11.
    Boolchand V, Faulx A, Das A, et al.: Primary care physician attitudes toward endoscopic screening for GERD symptoms and unsedated esophagoscopy. Gastrointest Endosc 2006, 63:228–233.PubMedCrossRefGoogle Scholar
  12. 12.
    Bretagne JF, Honnorat C, Richard-Molard B, et al.: Perceptions and practices on the management of gastro-oesophageal reflux disease: results of a national survey comparing primary care physicians and gastroenterologists. Aliment Pharmacol Ther 2007, 25:823–833.PubMedCrossRefGoogle Scholar
  13. 13.
    Dent J, Armstrong D, Delaney B, et al.: Symptom evaluation in reflux disease: workshop background, processes, terminology, recommendations, and discussion outputs. Gut 2004, 53(Suppl 4):iv1–iv24.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilcox CM, Alexander LN, Clark WS: Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci 1995, 40:2192–2196.PubMedCrossRefGoogle Scholar
  15. 15.
    Wo JM, Mendez C, Harrell S, et al.: Clinical impact of upper endoscopy in the management of patients with gastroesophageal reflux disease. Am J Gastroenterol 2004, 99:2311–2316.PubMedCrossRefGoogle Scholar
  16. 16.
    van Kerkhoven LA, van Rijswijck SJ, van Rossum LG, et al.: Is there any association between referral indications for open-access upper gastrointestinal endoscopy and endoscopic findings? Endoscopy 2007, 39:502–506.PubMedCrossRefGoogle Scholar
  17. 17.
    Okamoto K, Iwakiri R, Mori M, et al.: Clinical symptoms in endoscopic reflux esophagitis: evaluation in 8031 adult subjects. Dig Dis Sci 2003, 48:2237–2241.PubMedCrossRefGoogle Scholar
  18. 18.
    Locke GR, Zinsmeister AR, Talley NJ: Can symptoms predict endoscopic findings in GERD? Am J Gastroenterol 2003, 58:661–670.Google Scholar
  19. 19.
    Mantynen T, Farkkila M, Kunnamo I, et al.: The impact of upper GI endoscopy referral volume on the diagnosis of gastroesophageal reflux disease and its complications: a 1-year cross-sectional study in a referral area with 260,000 inhabitants. Am J Gastroenterol 2002, 97:2524–2529.PubMedCrossRefGoogle Scholar
  20. 20.
    Varadarajulu S, Eloubeidi MA, Patel RS, et al.: The yield and the predictors of esophageal pathology when upper endoscopy is used for the initial evaluation of dysphagia. Gastrointest Endosc 2005, 61:804–808.PubMedCrossRefGoogle Scholar
  21. 21.
    Kulig M, Nocon M, Vieth M, et al.: Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the ProGERD study. J Clin Epidemiol 2004, 57:580–589.PubMedCrossRefGoogle Scholar
  22. 22.
    Cook MB, Wild CP, Forman D: A systematic review and meta-analysis of the sex ratio for Barrett’s esophagus, erosive reflux disease, and nonerosive reflux disease. Am J Epidemiol 2005, 162:1050–1061.PubMedCrossRefGoogle Scholar
  23. 23.
    Lundell LR, Dent J, Bennett JR, et al.: Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999, 45:172–180.PubMedCrossRefGoogle Scholar
  24. 24.
    Ouatu-Lascar R, Triadafilopoulos G: Complete elimination of reflux symptoms does not guarantee normalization of intra-esophageal acid reflux in patients with Barrett’s esophagus. Am J Gastroenterol 1998, 93:711–716.PubMedCrossRefGoogle Scholar
  25. 25.
    Voutilainen M, Mantynen T, Mauranen K, et al.: Is it possible to reduce endoscopy workload using age, alarm symptoms and H. pylori as predictors of peptic ulcer and oesophagogastric cancers? Dig Liver Dis 37:526–532.Google Scholar
  26. 26.
    Nandurkar S, Locke GR III, Murray JA, et al.: Rates of endoscopy and endoscopic findings among people with frequent symptoms of gastroesophageal reflux in the community. Am J Gastroenterol 2005, 100:1459–1465.PubMedCrossRefGoogle Scholar
  27. 27.
    Adang RP, Vismans JF, Talmon JL, et al.: Appropriateness of indications for diagnostic upper gastrointestinal endoscopy: association with relevant endoscopic disease. Gastrointest Endosc 1995, 42:390–397.PubMedCrossRefGoogle Scholar
  28. 28.
    Numans ME, van der Graaf Y, de Wit NJ, de Melker RA: How useful is selection based on alarm symptoms in requesting gastroscopy? An evaluation of diagnostic determinants for gastro-oesophageal malignancy. Scand J Gastroenterol 2001, 36:437–443.PubMedCrossRefGoogle Scholar
  29. 29.
    Sung JJ, Lao WC, Lai MS, et al.: Incidence of gastroesophageal malignancy in patients with dyspepsia in Hong Kong: implications for screening strategies. Gastrointest Endosc 2001, 54:454–458.PubMedCrossRefGoogle Scholar
  30. 30.
    Manes G, Balzano A, Marone P, et al.: Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines. Aliment Pharmacol Ther 2002, 16:105–110.PubMedCrossRefGoogle Scholar
  31. 31.
    Kapoor N, Bassi A, Sturgess R, Bodger K: Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005, 54:40–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Liou JM, Lin JT, Wang HP, et al.: The optimal age threshold for screening upper endoscopy for uninvestigated dyspepsia in Taiwan, an area with a higher prevalence of gastric cancer in young adults. Gastrointest Endosc 2005, 61:819–825.PubMedCrossRefGoogle Scholar
  33. 33.
    Bowrey DJ, Griffin SM, Wayman J, et al.: Use of alarm symptoms to select dyspeptics for endoscopy causes patients with curable esophagogastric cancer to be overlooked. Surg Endosc 2006, 20:1725–1728.PubMedCrossRefGoogle Scholar
  34. 34.
    Wallace MB, Durkalski VL, Vaughan J, et al.: Age and alarm symptoms do not predict endoscopic findings among patients with dyspepsia: a multicentre database study. Gut 2001, 49:29–34.PubMedCrossRefGoogle Scholar
  35. 35.
    Parente F, Bargiggia S, Bianchi PG: Prospective audit of gastroscopy under the “three-day rule”: a regional initiative in Italy to reduce waiting time for suspected malignancy. Aliment Pharmacol Ther 2002, 16:1011–1014.PubMedCrossRefGoogle Scholar
  36. 36.
    Meineche-Schmidt V, Jorgensen T: “Alarm symptoms” in patients with dyspepsia: a three-year prospective study from general practice. Scand J Gastroenterol 2002, 37:999–1007.PubMedCrossRefGoogle Scholar
  37. 37.
    Boldys H, Marek TA, Wanczura P, et al.: Even young patients with no alarm symptoms should undergo endoscopy for earlier diagnosis of gastric cancer. Endoscopy 2003, 35:61–67.PubMedCrossRefGoogle Scholar
  38. 38.
    Lieberman D, Fennerty MB, Morris CD, et al.: Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository. Gastroenterology 2004, 127:1067–1075.PubMedCrossRefGoogle Scholar
  39. 39.
    Vakil N, Moayyedi P, Fennerty MB, Talley NJ: Limited value of alarm features in the diagnosis of upper gastrointestinal malignancy: systematic review and meta-analysis. Gastroenterology 2006, 131:390–401.PubMedCrossRefGoogle Scholar
  40. 40.
    Fransen GA, Janssen MJ, Muris JW, et al.: Meta-analysis: the diagnostic value of alarm symptoms for upper gastro-intestinal malignancy. Aliment Pharmacol Ther 2004, 20:1045–1052.PubMedCrossRefGoogle Scholar
  41. 41.
    Oda K, Iwakiri R, Hara M, et al.: Dysphagia associated with gastroesophageal reflux disease is improved by proton pump inhibitor. Dig Dis Sci 2005, 50:1921–1926.PubMedCrossRefGoogle Scholar
  42. 42.
    Lieberman DA, Oehlke M, Helfand M: Risk factors for Barrett’s esophagus in community-based practice. Am J Gastroenterol 1997, 92:1293–1297.PubMedGoogle Scholar
  43. 43.
    Blustein PK, Beck PL, Meddings JB, et al.: The utility of endoscopy in the management of patients with gastro-esophageal reflux symptoms. Am J Gastroenterol 1998, 93:2508–2512.PubMedCrossRefGoogle Scholar
  44. 44.
    Panter SJ, O’Flanagan H, Bramble MG, Hungin AP: Empirical use of antisecretory drug therapy delays diagnosis of upper gastrointestinal adenocarcinoma but does not effect outcome. Aliment Pharmacol Ther 2004, 19:981–988.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  1. 1.Division of Gastroenterology/HepatologyUniversity of LouisvilleLouisvilleUSA

Personalised recommendations