Endoscopy is relatively insensitive for making the diagnosis of gastro esophageal reflux disease. However, the presence of erosive esophagitis and/or BE is highly suggestive of GERD. The presence of normal mucosa at endoscopy does not rule out the diagnosis of GERD. At present, the role of biopsies in these situations is unsettled and more data are needed. Newer endoscopic techniques such as chromoendoscopy, magnification and high resolution may demonstrate minimal changes in the distal squamous mucosa such as punctate erythema, pinpoint vessels etc. not seen by standard endoscopy. Some of these changes may respond to therapy with proton pump inhibitor. Endoscopy remains the best test to rule out complications of GERD and allows histological confirmation of esophageal pathology such as intestinal metaplasia, dysplasia and adenocarcinoma. Identifying the patient group with severe erosive esophagitis, BE and peptic strictures may help focus aggressive management that may potentially prevent future complications in these patient groups.

Finally, endoscopy may be useful to rule out other diseases in the upper gastrointestinal tract.

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