Identifying Barrett's Esophagus Risk in a Primary Care Setting

Abstract

Barrett’s esophagus incidence has been on the rise for the past four decades. Early identification of Barrett’s esophagus is essential to preventing the morbidity and mortality associated with esophageal adenocarcinoma, a malignancy with an 18% five-year survival rate. With no national standard for screening, primary care providers must identify and refer patients who are at high risk of Barrett’s esophagus for endoscopic evaluation. This quality improvement project aimed to develop a protocol to identify patients at high risk for Barrett’s esophagus. Risk assessment was accomplished with a patient-completed over-the-counter medication survey and GerdQ questionnaire to identify patients with gastroesophageal reflux disease. When gastroesophageal reflux disease (GERD) was identified, providers assessed for the presence of additional Barrett’s esophagus risk factors. During the 14-week implementation period, 79 patients were evaluated. Over-the-counter medications were used by 64% of patients, and 37% reported using over-the-counter reflux medication at least monthly. A diagnosis of GERD was identified in 29% of the patients. Of the 79 patients completing the tools, 62 were evaluated for Barrett’s esophagus risk, with 15% identified as high risk and 6% meeting the criteria for endoscopic screening. The use of the over-the-counter survey and GerdQ questionnaire were effective for identification of Barrett’s esophagus high risk in this primary care practice. Recommendations were made for the use of these tools at the time of colorectal cancer screening referral to facilitate risk assessment and concurrent referral for Barrett’s esophagus screening if needed.