Although screening for esophageal adenocarcinoma has focused on identifying Barrett’s esophagus in persons with severe, long-standing symptoms of gastroesophageal reflux disease (GERD), a recent study has shown that medically treated patients with mild or absent GERD symptoms have significantly higher odds of developing this form of cancer.

“This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity,” noted the investigators (Arch Surg. 2011;146:851-858).

Many people who develop adenocarcinoma are unaware that they have Barrett’s esophagus, a change in the cells lining the esophagus, often due to repeated exposure to stomach acids that can develop into esophageal cancer.

In a study of 769 GERD patients presenting for their first upper endoscopy, Barrett’s esophagus or adenocarcinoma was discovered in 15.9%. Those who were adequately managing their GERD symptoms with proton-pump inhibitors (PPIs) were 61% more likely to have Barrett’s esophagus or adenocarcinoma if they reported no severe GERD symptoms, compared with PPI users who reported severe symptoms.

Results showed that even patients without severe GERD symptoms may benefit from Barrett’s esophagus screening, so that the condition can be identified before it becomes cancerous.