Oct. 27, 2022 — Adults who have chronic gastroesophageal reflux disease (GERD) and their primary care doctors may not know they need to be screened for a condition called Barrett’s esophagus, a precursor to cancer of the esophagus.
People with GERD are at risk for Barrett’s and cancer of the esophagus. Yet in a survey of 472 adults with GERD, only 13% had ever been advised by their doctor to undergo screening endoscopy and even fewer actually had the imaging test.
“These results make it clear that screening is rarely done,” says Jennifer Kolb, MD, with UCLA School of Medicine, who worked on the survey.
About 20% of people in the United States have GERD, which happens when stomach acid repeatedly flows back into the esophagus, the tube connecting the mouth and stomach. This backflow (acid reflux) can irritate the lining of the esophagus.
People with GERD may have heartburn, a burning sensation in the back of 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 becomes damaged by acid reflux. Barrett’s esophagus is associated with a small increased risk of developing cancer of the esophagus.
Current guidelines recommend screening for Barrett’s esophagus using endoscopy – in which a long, thin 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 being over 50 years old, being male or white, smokers, people with obesity, and those with family history of Barrett’s or cancer of the esophagus.
But the current survey shows a clear lack of knowledge about risk factors and indications for Barrett’s screening among adults with GERD.
Only about two-thirds correctly identified Barrett’s risk factors and only about 20% believed screening was necessary with GERD.
“If you have three or more risk factors, screening should definitely be discussed and considered,” says Prasad Iyer, MD, with Mayo Clinic in Rochester, MN.
Yet this survey shows that patients with GERD “don’t have the knowledge of when they should get medical attention and possibly endoscopy,” adds Seth Gross, MD, with NYU Langone Health in New York City.
People of color with GERD appear to be most worried about developing Barrett’s but have the highest barriers to completing screening.
For some people, fear of discomfort with endoscopy is a barrier to getting the test.
To perform an endoscopy, a 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 inspect the lining of the esophagus and remove a small sample of tissue toconfirm a diagnosis of Barrett’s.
However, newer, less invasive screening options are increasingly available or in development.
One is the so-called Cytosponge, a small, capsule-shaped device the size of a multivitamin. A thin string 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. As it’s removed, the sponge collects cells from the entire length of your esophagus, which are used to make a diagnosis of Barrett’s.