unfortunately most cancers of the esophagus are detected too late to be treated effectively. by the time cancer-related symptoms of chest pain weight loss and progressive difficulty in swallowing (dysphagia) lead to the diagnosis the cancer has already spread beyond the esophagus to other organs. indeed there is evidence that survival is markedly improved in cancers detected during the course of surveillance for dysplasia or cancer in barrett's esophagus as compared with survival in cancers detected after cancer symptoms prompted medical attention. therefore physicians want to make the diagnosis of barrett's in gerd patients and then begin surveillance for cancer in such patients. the problem however as mentioned previously is that only 5% of all patients with adenocarcinomas of the esophagus or cardia have had an endoscopy to show that they have barrett's esophagus. thus the challenge is to identify those gerd patients who have barrett's by screening patients with chronic gerd. yet sufficient research has not been done to establish guidelines for selecting which patients with gerd should be screened by endoscopy. for now until more data becomes available it seems reasonable that if a patient with gerd cannot be taken off acid-suppressing drugs after two to three years (because of persistent symptoms) an endoscopy should be done to see if barrett's esophagus is present. one endoscopy per lifetime in patients with gerd may be sufficient to screen for barrett's.
why is it important to screen patients with gerd to diagnose barrett's esophagus?