Reflux self-medication and limited healthcare consultation: Systemic inadequacies in Barrett’s esophagus screening, surveillance, and management

Table 1 Barriers to Barrett’s esophagus screening and mitigation strategies

Category	Key barriers	Supporting evidence	Potential strategies/mitigations
Patient-related	Under-recognition of reflux significance; symptom masking by long-term OTC acid suppressants; low awareness of cancer risk	57.5% never consulted physician; 36.6% regular OTC use[4]; low awareness of dysphagia as alarm symptom[6]	Public education on reflux-related cancer risk; proactive non-endoscopic screening tools (e.g., Cytosponge-TFF3)
Physician-related	Limited systematic reflux history-taking in primary care; reliance on spontaneous reporting; suboptimal guideline knowledge	Missed opportunities despite multiple risk factors[11]; marked deficiencies in familiarity with screening recommendations[38]	Targeted primary care education; structured reflux questionnaires; integration of risk-prediction models into electronic health records
System-level	Fragmented care pathways; decentralized surveillance in low-volume settings; inconsistent referral to expert centers	Seattle protocol adherence 50%-70%; poor surveillance interval compliance; dysplasia management not centralized[29,38,39]	Dedicated Barrett’s lists; mandatory high-volume centers for dysplastic cases; national quality registries
Epidemiological	Rising central obesity; high proportion of asymptomatic BE; geographic and racial variations in symptom expression	Escalating obesity prevalence[10]; up to 60% of BE cases asymptomatic[13,14]; racial differences in complication rates[8-10]	Population-based risk stratification; broader use of non-symptom-dependent screening approaches

BE: Barrett’s esophagus; OTC: Over-the-counter.