Curbside Consults Podcast

By Clement Lee, MD, MSc

Published July 20, 2022

In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of Barrett’s esophagus by the American College of Gastroenterology (ACG). We are joined by Dr. Nick Shaheen, a Professor of Medicine and Chief of Gastroenterology and Hepatology at UNC Chapel Hill, and one of the guideline authors.

00:05 – Intro
00:35 – Guideline process
01:50 – Basics of Barrett’s esophagus
04:27 – Which patients should we screen?
07:40 – Consideration of patients without reflux
08:53 – Strength of evidence of screening
10:50 – Discrepancies in endoscopy utilization
12:20 – Recommended modalities for screening
16:30 – Repeat endoscopy is unnecessary
18:20 – Exception: severe esophagitis on initial screen
19:35 – Treatment of Barrett’s esophagus
21:37 – Acid suppression for Barrett’s esophagus
23:37 – No evidence for antireflux surgery
25:00 – Concluding remarks

Articles discussed in this episode:

1. Shaheen NJ et al. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol 2022.
2. Fitzgerald RC et al. Cytosponge-Trefoil Factor 3 Versus Usual Care To Identify Barrett’s Oesophagus in a Primary Care Setting: A Multicentre, Pragmatic, Randomised Controlled Trial. Lancet 2020.
3. Shaheen NJ et al. Radiofrequency Ablation in Barrett's Esophagus with Dysplasia. N Engl J Med 2009.
4. Jankowski JAZ et al. Esomeprazole and Aspirin in Barrett's Oesophagus (AspECT): A Randomised Factorial Trial. Lancet 2018.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

Nick Shaheen, MD, is Professor of Medicine and Chief of Gastroenterology and Hepatology at UNC Chapel Hill.
Clement Lee, MD, MSc, is a 2021–2022 NEJM Editorial Fellow. He is currently an internal medicine hospitalist at Beth Israel Deaconess Medical Center and a pediatric hospitalist at Lowell General Hospital. He completed his internal medicine-pediatrics residency at Penn-CHOP.