Could your repeat PPI list become a Barrett’s screening list?

Practices can search their records for patients aged 50 and over on repeat PPIs. A new study asked a simple question. What happens if you invite them for a Barrett’s test?¹

Barrett’s oesophagus is the precursor to oesophageal adenocarcinoma. It is found in 3 to 6% of people with reflux.¹

We cannot scope everyone with reflux. British Society of Gastroenterology guidance says endoscopic screening can be considered in people with chronic reflux symptoms and multiple risk factors. That means at least three of: age 50 or over, white ethnicity, male sex and obesity.² But it does not recommend actively looking for these patients.¹

NICE says not to routinely offer endoscopy to diagnose Barrett’s. Instead, it can be considered in people with reflux after discussing their preferences and individual risk factors.³

The capsule sponge offers another route. It is a 10-minute test done without endoscopy. The patient swallows a capsule sponge, which collects cells from the oesophagus for a lab test. A positive result leads to endoscopy.¹

In the BEST3 trial, offering the test to people with reflux found 10 times more Barrett’s than usual care.⁴ But only 24% of patients invited by their GP took it up.¹

The DELTA study set out to do better.¹ Between June 2021 and January 2023, three practices in the East of England searched their records for patients aged 50 and over on a repeat PPI. Each patient got a letter from their GP. The test took place in a mobile unit parked locally. The team also advertised locally so people could refer themselves.

Of 3,293 people invited, about half replied. Of those who were interested and could be contacted, two thirds were eligible. In the end, 502 swallowed a capsule sponge.

That is only 15% of everyone invited. But it is 87.5% of those who were eligible and interested.

Another 525 people came forward by themselves. Of those who could be contacted in time, about half were eligible. In the end, 208 swallowed the sponge.

The test itself went down well. Nearly 95% of participants successfully swallowed the sponge. Over 99% found it acceptable, and 97% said they would do it again.

About 1 in 10 people were referred for endoscopy. Of those who had an endoscopy with a known result, 42% had Barrett’s. Overall, Barrett’s was found in 4.2% of GP-invited patients and 3.4% of self-referrals. Three had dysplasia.

Among GP-invited patients, 24 people swallowed a sponge for every Barrett’s diagnosis.

The study also shows where invitations fall down. Of those who returned a slip saying no, almost a third did not think they could swallow the capsule. Another 30% had more important health issues to deal with.

A quarter believed they were not eligible. Some no longer had reflux symptoms. Others were taking a PPI for a different reason, such as protection alongside another medicine.

The practice searches were not perfect either. Some interested GP-invited patients turned out to be ineligible. Of these, a third had already had an endoscopy in the past five years. Almost a fifth were taking a PPI alongside another medicine rather than for reflux. The authors say coding varied within and between practices, and that better searches would make invitations more efficient.

Follow-up was a problem for GP-invited patients. Of those referred for endoscopy, 18% declined or were lost to follow-up, compared with 4% of self-referrals.

There are limits. The study ran at three sites in one region, partly during the COVID-19 pandemic. People with a negative test were not scoped, so the false negative rate is unknown. The capsule sponge technology is licensed to Medtronic, and several authors declare related interests.¹

The capsule sponge is not yet standard care for reflux in England.¹ That may change.

The BEST4 Screening Trial is now testing whether capsule sponge screening reduces oesophageal adenocarcinoma incidence and mortality in people with reflux who regularly use acid-suppressing medicines. It will use mobile units and self-referral, both shaped by this study.¹

For now, nothing changes in how reflux is managed. But the list this study started from can be pulled from routine practice records. If BEST4 shows a benefit, that search could become a starting point for screening.

References

1.        Landy R, Waller J, Debiram-Beecham I, et al. Using a mobile unit to deliver capsule sponge testing for Barrett’s oesophagus in the community in England through GP invitation and self-referral: an implementation study. BMJ Open Gastroenterol. 2026;13:e002496. doi:10.1136/bmjgast-2026-002496

2.        Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7-42. doi:10.1136/gutjnl-2013-305372

3.        National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184). London: NICE; 2014, updated 2019. https://www.nice.org.uk/guidance/cg184

4.        Fitzgerald RC, di Pietro M, O’Donovan M, 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;396:333-44. doi:10.1016/S0140-6736(20)31099-0