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Hot off the press: Stop referring these patients with GERD

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.

Reference Canadian Task Force on Preventive Health Care

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

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The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.