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Missed Opportunities in GERD Complication Screenings

High-risk patients don't always get endoscopic examination for Barrett's esophagus, cancer, say researchers.

Published: January 29, 2014

Men aged 65 years and older are much more likely to suffer the complications of gastroesophageal reflux disease (GERD), such as Barrett's esophagus and esophageal, gastric or duodenal cancer, but they're much less likely to undergo endoscopic screenings that can detect these complications, according to recent research.

At the same time, the research points out that esophagogastroduodenoscopy (EGD) is often overused among patients with a lower risk of these complications.

This discrepancy is highlighted in a letter published online by JAMA Internal Medicine on Jan. 27. Researchers affiliated with U.S. Department of Veterans Affairs Health Services Research & Development reviewed the cases of 499,073 who'd been diagnosed for the first time with uncomplicated GERD.

"This mismatch between high-risk groups and likelihood of receiving EGD may contribute to missed opportunities for conducting effective screening EGD," researchers say.

An invited commentary notes that an underutilization of EGD among the highest risk patients may let them slip through the diagnostic net. "We still miss most patients with [Barrett's esophagus] despite the widespread use of EGD; up to 95% of cases of adenocarcinoma occur in the setting of no prior diagnosis of BE," they write.

Practice guidelines from the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology recommend EGD screenings for high-risk GERD patients, which include white men over 50 years old who have been suffering symptoms for more than 5 years and have a family history of Barrett's esophagus or esophageal cancer.

David Bernard

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