screening for BE and dysplasia. Endoscopy may also play a main role in the concept of "alarm symptoms" although a recent meta-analysis showed that they performed poorly as diagnostic tests. Proposed alarm symptoms include vomit- ing, weight loss, dysphagia, anemia, signs of gastrointestinal blood loss, chest pain, or epigastric mass [47]. Among them dysphagia and especially troublesome dysphagia warrants endoscopic evaluation because it can be indicative of a stricture or malignancy. Moreover, in GERD patients with dysphagia without obvious obstructing lesion the potential value of endoscopy with increases as eosinophilic esophagitis is recognized as a confounding clinical entity [48]. There is no evidence to support the utility of routine esophageal biopsies in patients with reflux symptoms without dysphagia