The endoscopy question is an interesting one.
I'm a bit out of the loop, perhaps some GI bod's could chip in.
Questions I would need to know the answers to:
How long have you had the symptoms ?
Are there any potential "sinister" symptoms eg weight loss, persistent vomiting.
What are the risks of complications of performing an endoscopy, and what is the ball park figure?
What is the risk of those complications killing me?
I think ultimately,
will this investigation make a difference to this patient ? or should I just prescribe the ppi anyway ?
I am, of course, looking at this from a population perspective, but worth bearing in mind that most of the population will suffer "heartburn/reflux" (whatever you want to call it, I'll call it undiagnosed dyspepsia for now).
The figures I used to work on were 1:1000 for perforation through endoscopy, 1:10000 for death through endoscopy, 1:250000 missing a gastric cancer for not doing endoscopy (with no "red flags")
Like I say, things have moved on, and I am aware of the new NICE 2 week stuff for us in Primary Care, just interested if any other GI experts had an opinion.