Adults with chronic gastroesophageal reflux disease (GERD) are astatine accrued hazard for Barrett's esophagus (BE) — the precursor to esophageal adenocarcinoma (EAC) — but astir don't acquisition recommended screening, caller probe shows.
Jennifer Kolb, MD, with UCLA David Geffen School of Medicine, Los Angeles, and colleagues surveyed 472 adults with chronic GERD who suffice for BE screening and had a caller sojourn with their superior attraction provider.
In this divers colonisation of radical astatine hazard for BE and EAC, lone 13% had ever been advised to acquisition endoscopy to surface for BE and lone 5% really had a anterior screening, the survey notes.
"These results marque it wide that screening is seldom done," Kolb told Medscape Medical News.
The results of the survey are published online successful the American Journal of Gastroenterology.
Concern High, Understanding Low
Esophageal cancer and BE person accrued among middle-aged adults implicit astir the past 5 years, and this summation is not due to the fact that of amended oregon much predominant screening, arsenic reported previously by Medscape Medical News.
In fact, the bulk of patients who make EAC bash not person a anterior diagnosis of BE, which highlights the nonaccomplishment of existent BE screening practices, Kolb and colleagues constituent out.
Professional gastroenterology nine guidelines urge screening for BE utilizing precocious endoscopy for at-risk individuals, which includes those with chronic GERD, on with different hazard factors specified arsenic property older than 50 years, antheral sex, achromatic race, smoking, obesity, and household past of BE oregon EAC.
In the existent survey, astir individuals said aboriginal detection of BE/EAC is important and leads to amended outcomes, but astir had mediocre wide cognition connected hazard factors and indications for screening.
Only astir 2 thirds of respondents correctly identified BE hazard factors, and lone astir 20% believed BE screening was indispensable with GERD, the researchers note.
Roughly 2 thirds of individuals wanted to prioritize BE screening and felt that getting an precocious endoscopy would easiness their concern.
Yet, 40% had nary anterior esophagogastroduodenoscopy (EGD). These individuals were little knowledgeable astir BE/EAC hazard and screening recommendations and identified much barriers to completing endoscopy.
"While minorities were astir acrophobic astir processing Barrett's esophagus and cancer, they reported much barriers to screening compared to White participants," Kolb said.
Addressing Knowledge Gaps
The superior attraction clinician is often the archetypal enactment for patients with symptomatic acerb reflux and the gateway for preventive crab screening.
Yet, research has shown that superior attraction clinicians often person occupation identifying who should beryllium screened for BE, and competing objective issues marque it challenging to instrumentality BE screening.
"As gastroenterologists, we indispensable spouse with our superior attraction colleagues to assistance summation consciousness of this lethal illness and amended designation of hazard factors truthful that eligible patients tin beryllium identified and referred for screening," Kolb said.
Reached for comment, Seth Gross, MD, objective main of the part of gastroenterology and hepatology astatine NYU Langone Health successful New York City, said the results "shed airy connected the information that patients with GERD don't person the cognition of erstwhile they should get aesculapian attraction and perchance endoscopy."
"We whitethorn request to bash a amended occupation of educating our colleagues and patients to cognize erstwhile to question specialists to perchance get an endoscopy," Gross said.
About 90% of esophageal cancers are diagnosed extracurricular of surveillance programs, noted Prasad G. Iyer, MD, a gastroenterologist astatine Mayo Clinic successful Rochester, Minnesota.
"Patients didn't adjacent cognize that they had Barrett's [esophagus], truthful they were ne'er nether surveillance. They lone travel to attraction aft they person occupation with nutrient sticking, and they can't swallow coagulated food," said Iyer, who besides wasn't progressive successful the survey.
"Unfortunately, determination are conscionable truthful galore cancers and truthful galore issues that superior attraction providers person to woody with that I deliberation this whitethorn not beryllium getting the attraction it deserves," helium said.
Access to endoscopy is besides apt a barrier, Iyer noted.
"The waiting database whitethorn beryllium respective months, and I deliberation providers whitethorn absorption connected different things," helium said.
Less-Invasive Screening Options
Fear of endoscopy whitethorn beryllium different issue.
In their survey, Kolb and colleagues recovered that 20% of respondents reported fearfulness of discomfort with endoscopy arsenic a obstruction to completing screening.
But little invasive screening options are progressively disposable oregon successful development.
This includes Cytosponge, a swallowable capsule containing a compressed sponge attached to a string. When withdrawn, the sponge contains esophageal cytology samples that tin beryllium utilized to place biomarkers for BE.
In a line released past spring, the American College of Gastroenterology endorsed Cytosponge arsenic a non-endoscopic BE screening modality, as reported by Medscape Medical News.
"The spot of the proposal is conditional, but it's the archetypal clip wherever [the ACG] is saying that this whitethorn beryllium an enactment for people," Gross said.
This probe was funded by the American College of Gastroenterology. Kolb, Gross, and Iyer study nary applicable fiscal relationships.
Am J Gastroenterol. Published online October 10, 2022. Abstract
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