Oct 27, 2022 — Adults with chronic gastroesophageal reflux disease and primary care physicians may not know they need to be screened for a condition called Barrett’s esophagus, a precursor to esophageal cancer.
People with GERD are at risk of developing Barrett’s disease and esophageal cancer. However, in a survey of 472 adults with GERD, only 13% were advised by their doctor to undergo endoscopy for screening, and fewer had actually undergone an imaging test.
“These results show that the scan is rarely performed,” says Jennifer Kolb, MD, a physician at the University of California, Ph.D., who worked on the survey.
About 20% of people in the United States have GERD, which occurs when stomach acid repeatedly backs up into the esophagus, the tube that connects the mouth to the stomach. This reflux (acid reflux) can irritate the lining of the esophagus.
People with GERD may have heartburn, a burning sensation in the back of the throat, a chronic cough, sore throat, and nausea.
About 1 in 10 adults with symptoms of chronic GERD will have Barrett’s esophagus — a condition in which the lining of the esophagus is damaged by acid reflux. Barrett’s esophagus is associated with an increased risk of esophageal cancer.
Current guidelines recommend an examination of Barrett’s esophagus using endoscopy — where a thin, long tube is inserted into the body to look for problems — for those at risk, which includes people with chronic GERD along with other risk factors such as over age 50. Older adults, males or whites, smokers, people who are obese, and those with a family history of Barrett’s disease or esophageal cancer.
But the current survey shows a clear lack of knowledge about the risk factors and indications for Barrett’s examination among adults with GERD.
Only about two-thirds correctly identified Barrett’s risk factors and only about 20% believe that screening is necessary with GERD.
“If you have three or more risk factors, screening should definitely be discussed and considered,” says Prasad Iyer, MD, with the Mayo Clinic in Rochester, Minnesota.
However, this survey shows that patients with GERD “have no knowledge of when to seek medical care and possibly an endoscopy,” adds Seth Gross, MD, of New York University Langone Health in New York City.
People of color with GERD appear to be more concerned about developing Barrett’s disease but have the greatest barriers to completing screening.
For some people, the fear of discomfort during the endoscopy is a barrier to having the test.
To perform an endoscopy, the doctor inserts a long, flexible tube with a camera attached down the throat and into the esophagus after giving the patient a sedative. Once the tube is inserted, the doctor can visually examine the lining of the esophagus and remove a small sample of tissueConfirm the diagnosis of Barrett’s disease.
However, newer, less invasive screening options are increasingly available or under development.
The first is the so-called Cytosponge, a small capsule-shaped device the size of a multivitamin. A thin thread is attached to a sponge inside the capsule.
When you swallow the capsule it dissolves and the sponge expands. The thread is then gently pulled to remove the sponge. When removed, the sponge collects cells from the entire length of the esophagus, which are used to diagnose Barrett’s disease.
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