Barrett Esophagus: Updated Guideline Recommendations

Guideline Watch |
December 18, 2015

Barrett Esophagus: Updated Guideline Recommendations

  1. David A. Johnson, MD

Routine screening in women with gastroesophageal reflux disorder is not recommended.

  1. David A. Johnson, MD

Sponsoring Organization: American College of Gastroenterology (ACG)

Target Audience: Gastroenterologists, general internists

Background and Objective

Considerable controversy surrounds the cost-effectiveness of screening and surveillance for Barrett esophagus (BE) as well as the role of ablative therapies aimed at decreasing the related esophageal adenocarcinoma (EAC) risk. The ACG has evaluated the most current published clinical reports on this topic and now offers evidence-based, weighted recommendations on current best practices.

Key Recommendations

Screening

  • Do not routinely screen women with gastroesophageal reflux disease (GERD) symptoms.

  • Screen men with chronic (lasting >5 years) GERD symptoms and ≥2 risk factors for BE or EAC (age >50 years, Caucasian race, central obesity, current or past smoking history, and confirmed family history of BE or EAC).

Endoscopy

  • Do not perform biopsy if Z line is normal or has <1 cm of variability.

  • Use the Prague classification for reporting the circumferential and maximal segment length.

  • If the initial screening shows erosive esophagitis, repeat the exam to exclude BE after treating the patient for 8 to 12 weeks with a proton-pump inhibitor to heal esophagitis.

Endoscopic ablative therapy

  • Expand use to patients with low-grade dysplasia (LGD).

  • Do not use in patients with nondysplastic BE and no dysplasia on endoscopic mucosal resection (EMR).

  • Use in patients with low-grade or high-grade dysplastic lesions after complete resection by EMR.

  • Continue endoscopic surveillance following ablative therapy.

Comment

Of note, the clinical value of screening women with GERD for BE has been likened to the value of theoretical routine screening for breast cancer in men. Also notable is the recommendation against routine screening of men with GERD in the absence of other identified risks for BE or EAC. This new guideline is essential reading for clinicians who evaluate patients with BE.

Editor Disclosures at Time of Publication

  • Disclosures for David A. Johnson, MD at time of publication Consultant / Advisory board Medscape; Pfizer; CRH Medical Corporation; Covidien; Janssen; American Board of Internal Medicine; American College of Gastroenterology; WebMD Equity CRH Medical Corporation; Bovie Medical Corporation Editorial boards ACG Education Universe; Medscape Gastroenterology Leadership positions in professional societies American Board of Internal Medicine (Gastroenterology Examination Board); ACG Education Universe (Co-editor)

Citation(s):

Reader Comments (3)

MARGARET CONTE Physician, Family Medicine/General Practice, Margaret A. Conte, M.D,

I think this information is also applicable to those who are Family Physicians. I do not appreciate our specialty being excluded from those to whom these guidelines were intended.

Roberta Evans RN Other, Unspecified, Retired from Washington University School of Medicine

My (female) Barrett's Esophagus of 5 years standing, discovered while screening for severe GE, begs to differ.

lorie

I do not agree with this new guideline regarding BE in women. I have had reflux for many many years and still do even on PPI treatment for 20 plus years. How can I feel safe following the new gudeline?

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