- 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.
- 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.