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Although all three studies were cohort studies with acceptable quality scores on the NOS, the small number of studies still restricts the generalizability of the results

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Endoscopy may be used to evaluate people who do not respond to treatment for heartburn or those with alarm symptoms such as persistent vomiting, gastrointestinal bleeding, iron-deficiency anemia, involuntary weight loss, difficult/painful swallowing (dysphagia, odynophagia), epigastric mass, family history of esophageal or gastric cancer, and new onset of symptoms in those older than 50 years of age

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