Screening for Barrett’s esophagus (BE) based on risk factors followed by a comprehensive review of the epidemiology, pathogenesis, and employing latest techniques could be keys to detecting and eradicating BE, Dr Iyer said during his abstract presentation at the 2023 ACG Annual Scientific Meeting and Postgraduate Course on October 23, in Vancouver, Canada.

Dr Iyer is a professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota

“Gastroesophageal reflux disease (GERD) is a risk factor for BE,” Dr Iyer said. “Other risk factors include patients who are Caucasian, older than 50 years of age, obese, use tobacco regularly, and have a history of peptic stricture and erosive gastritis.”

While obesity has been an established risk factor for developing Barrett’s esophagus, “there appears to be a strong association between abdominal obesity (waist circumference) and Barrett’s, too,” Dr Iyer said.

Is endoscopy the answer for all patients with symptoms of GERD to diagnose Barrett’s esophagus? Dr Iyer said that endoscopy is not the general answer to managing Barrett’s. “Endoscopy should be reserved for only patients with GERD symptoms and multiple risk factors for Barrett’s.” For a patient with suspected Barrett’s, even if the histological examination does not show intestinal metaplasia, endoscopy with biopsies should be repeated at least once, possibly within 1-2 years.

Endoscopic surveillance for Barrett’s should ideally not continue for men more than 80 years old and women more than 75 years old, depending on patient age and comorbidities.

There is yet no indication of the need for an antireflux surgery for antineoplastic purposes among patients with Barrett’s, Dr Iyer added.

Reference:
Iyer P. Barrett’s esophagus: Practical tips and guidelines based care in 2023. Symposium 1A: Past president’s symposium. Presented at: 2023 ACG Postgraduate Course. Vancouver, Canada. October 23, 2023.