October 27, 2022 – Adults with chronic gastroesophageal reflux disease (GERD) and their primary care physicians may not know they need to be evaluated for a condition called Barrett’s esophagus, a precursor to esophageal cancer.
People with GERD are at risk for Barrett’s disease and esophageal cancer. But in a survey of 472 adults with GERD, only 13% had ever been advised by their doctor for a screening endoscopy, and even fewer had actually had the imaging test.
“These results make it clear that screening is rarely done,” says Jennifer Kolb, MD, of the UCLA School of Medicine, who collaborated on the survey.
About 20% of people in the United States have GERD, which happens when stomach acid repeatedly backs up into the esophagus, the tube that connects the mouth and stomach. This reflux (acid reflux) can irritate the lining of the esophagus.
People with GERD may experience heartburn, a burning sensation in the throat, chronic cough, laryngitis, and nausea.
About 1 in 10 adults with chronic GERD symptoms will develop Barrett’s esophagus — a condition in which the lining of the esophagus is damaged by acid reflux. Barrett’s esophagus is associated with a small increased risk of developing esophageal cancer.
Current guidelines recommend screening for Barrett’s esophagus using endoscopy — which involves inserting a long, thin tube into the body to look for problems — for at-risk individuals, which include those with chronic GERD along with other risk factors, such as: B. over 50 years old, male or white, smokers, people with obesity and people with family history of Barrett’s disease or esophageal cancer.
But the current survey shows a clear lack of knowledge about risk factors and indications for Barrett’s screening in adults with GERD.
Only about two-thirds correctly identified Barrett’s risk factors and only about 20% considered screening for GERD necessary.
“If you have three or more risk factors, screening should definitely be discussed and considered,” says Prasad Iyer, MD, of the Mayo Clinic in Rochester, MN.
However, this survey shows that patients with GERD “don’t know when to get medical attention and possibly an endoscopy,” adds Seth Gross, MD, of NYU Langone Health in New York City.
People of Color with GERD appear to be most concerned about Barrett’s development but have the greatest barriers to completing screening.
For some people, fear of discomfort during endoscopy is a barrier to the test.
To perform an endoscopy, a doctor inserts a long, flexible tube with an attached camera down the throat and into the esophagus after giving the patient a sedative. Once the tube is inserted, the doctor can visually inspect the lining of the esophagus and take a small sample of tissueconfirm a diagnosis of Barrett.
However, newer, less invasive screening options are increasingly available or under development.
One is called the Cytosponge, a small, capsule-shaped device the size of a multivitamin. A thin cord is connected to a sponge inside the capsule.
When swallowed, the capsule dissolves and the sponge expands. The string is then gently pulled to remove the sponge. When removed, the sponge collects cells from the entire length of your esophagus, which are used to diagnose Barrett’s disease.