Chronic GERD: should you screen for upper GI disease?

  • Groulx S & al.
  • CMAJ
  • 6 Jul 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • The Canadian Task Force on Preventive Health Care recommends against regular screening of adults with chronic gastroesophageal reflux disease (GERD) for esophageal adenocarcinoma, Barrett esophagus, or dysplasia.

Why this matters

  • The prevalence of GERD with weekly symptoms is 10%-20% in Europe and North America.

Key points

  • The guideline does not apply to patients with Barrett esophagus or those who have red-flag symptoms potentially caused by adenocarcinoma, such as dysphagia, odynophagia, recurrent vomiting, unexplained weight loss, anemia, loss of appetite, or gastrointestinal (GI) bleeding.
  • A literature review yielded no evidence for benefit of screening for esophageal adenocarcinoma or either of its precursor conditions (Barrett esophagus, dysplasia) in adult patients with GERD.
  • The harms associated with screening are uncertain, but there are associated costs, and screening may conflict with patient values and preferences.
  • Screening of chronic GERD patients was associated with the identification of more early-stage esophageal adenocarcinoma cases in 1 retrospective study, but there was no difference in long-term all-cause mortality.
  • Patient acceptance of screening varied widely.
    • Some embraced screening because of individual or familial risk factors, personal beliefs, or worry about being diagnosed in a more advanced stage.
    • Others did not like the invasiveness and potential risks of screening.