A 52-Year-Old Man With Heartburn: Should He Undergo Screening for Barrett's Esophagus?

Whether persons with GERD should be screened for BE is a common question of both primary care physicians and gastroenterologists alike. Current guidelines recommend either no screening or screening only in individuals at high risk of esophageal cancer. Esophageal cancer is a relatively rare entity in patients with heartburn, and the vast majority of patients with GERD are unlikely to benefit from screening for BE. The evidence supporting screening efforts is weak and inconsistent. Therefore, wide scale endoscopic screening in its currently practiced form cannot be recommended on a routine basis. Further developments in technology may make screening more effective and cost effective. Finally, the changing epidemiology of this cancer demands that we revisit this issue frequently, as the value of effective screening would presumably increase as the incidence of esophageal cancer rises. While lack of evidence in favor of endoscopic screening does not indicate lack of efficacy, until more data are available to support this practice, screening efforts might be better directed at interventions with proven benefits.