A recent review article in the journal Alimentary Pharmacology and Therapeutics outlines how often one should be screened for Barrett’s esophagus, a condition in which the acid from reflux changes the cellular structure of the esophageal lining. The article was written by S. J. Spechler and his colleagues at the Veterans Affairs Medical Center in Dallas
Chronic gastroesophageal reflux disease (GERD) and Barrett’s esophagus are associated with an increased risk of a rare esophageal cancer called esophageal adenocarcinoma. Because of this, the American College of Gastroenterology (ACG) recommends regular screening to patients with GERD symptoms. Researchers say this preventive measure is as effective in recognizing Barrett’s esophagus as regular mammograms are in screening for breast cancer. Catching Barrett’s esophagus early in its development allows patients and medical professionals to intervene and possibly prevent the development of cancer.
The primary procedure for detecting Barrett’s esophagus is an endoscopy. During an endoscopy a narrow tube with a small camera attached is inserted into the digestive tract. The doctor can use this to see what damage has occurred and identify conditions such as Barrett’s esophagus. The article suggests that all patients with GERD should have an upper endoscopy. Further testing, including biopsies, may be necessary to accurately diagnose a condition. Any patients who are found to have Barrett’s esophagus should repeat the endoscopy procedure every three years.
GERD can also lead to dysplasia, or abnormal cell development, in the lining of the esophagus. Patients who have been diagnosed with low-grade dysplasia should receive an endoscopy annually, while those with high-grade dysplasia may wish to undergo an endoscopy every three months. If the condition has advanced beyond that, more drastic measures such as an esophagectomy, the removal of the esophagus, may be considered.
The researchers' findings are somewhat at odds with the ACG’s recommendations for care. Because the cost of the test is relatively high, the ACG does not advise an endoscopy for patients who have only been diagnosed with GERD, because these patients are not yet at high risk for esophageal cancer. However, since Barrett’s esophagus is widely recognized as indicating increased risk for cancer, most physicians will perform endoscopies on patients who have been diagnosed with Barrett’s esophagus.
The researchers arrived at their recommended frequencies for testing using computer models, taking into account both the effectiveness and the cost of the tests.