Risk Stratification for Endoscopy in Symptomatic GERD Based on Clinical Predictors of Erosive Esophagitis and Significant Gastric Mucosal Injury

Upper gastrointestinal endoscopy is frequently performed in symptomatic gastroesophageal reflux disease (GERD), yet diagnostic yield is variable and symptom-based referral may lead to overuse. We evaluated clinical predictors of erosive esophagitis and significant gastric mucosal injury (SGMI) to support risk-based endoscopy triage. Fort-five adults with symptoms suggestive of GERD underwent esophagogastroduodenoscopy. Variables recorded included sex, BMI category, locality (rural/urban), hemoglobin status, and symptom profile. Erosive esophagitis was defined as Los Angeles grade A–D. SGMI was defined as erosive gastropathy/erosive gastritis and/or ulcerative lesions. Predictors were analyzed using univariate testing and multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (CI). Endoscopy revealed gastritis/gastropathy in 71.1% (32/45), esophagitis in 68.9% (31/45), and hiatal hernia in 44.4% (20/45); 11.1% had normal endoscopy. In univariate analysis for erosive esophagitis, male sex (38.7% vs 7.1%; p=0.028), BMI ≥25 kg/m² (48.4% vs 14.3%; p=0.032), and heartburn/reflux (87.1% vs 57.1%; p=0.024) were significant. In multivariable regression, BMI ≥25 kg/m² independently predicted erosive esophagitis (aOR 4.20; 95% CI 1.02–17.18; p=0.047) and heartburn/reflux remained significant (aOR 4.70; 95% CI 1.12–19.63; p=0.034). For SGMI, anemia (Hb <12 g/dL) (66.7% vs 29.6%; p=0.014) and dyspepsia (83.3% vs 51.9%; p=0.031) were significant; both remained independent predictors (Hb <12: aOR 3.60; 95% CI 1.12–11.62; p=0.031; dyspepsia: aOR 3.10; 95% CI 1.01–9.60; p=0.048; AUC 0.76). Simple clinic-based predictors can stratify symptomatic GERD patients for endoscopy, improving diagnostic yield for erosive and significant gastric mucosal disease.