by Dr. Simon Moore MD CCFP
Today the Canadian Task Force on Preventive Health Care (CTFPHC) released their long-awaited guideline update on screening adult patients for Esophageal Cancer. What's the verdict - should GERD patients be referred for endscopy?
In a word, DON'T.
Even if they've had long-term gastroesophagal reflux disease, there is no statistically significant difference in those screened compared to those who are not.
There are some exceptions to know, plus you should be able to determine if the patient is at risk.
Below is a list of the risk factors from the CTFPHC (which you should be able to list if you’re studying for SAMPs). Interestingly, even if patients have risk factors, the new guideline states there’s not enough evidence to recommend screening these patients:
Age ≥ 50 years
Male sex
Family history
White race or ethnicity
Abdominal obesity
Smoking
Exception 1:
Needless to say, if a patient has symptoms, it is no longer screening and this guideline does not apply to them. Patients with alarm symptoms should absolutely be referred urgently. These symptoms include:
Dysphagia
Odynophagia
Recurrent vomiting
Unexplained weight loss
Anemia
Anorexia
Gastrointestinal blood loss
Exception 2:
Patients with a previous diagnosis of Barrett’s Esophagus are also not included in this guideline.
Also of note – this recommendation is listed as “strong recommendation; very low-certainty evidence.” So, as always, your clinical judgement should prevail.
GERD = Gastroesophageal reflux disease
Photo credit By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34333137