Barrett’s oesophagus: diagnosis and management
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2373 (Published 11 May 2016) Cite this as: BMJ 2016;353:i2373
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The journal’s enduring devotion and efforts for EBM must be commended, however consistency is always difficult to achieve.
McCartney et al, analysing the barriers to EBM implementation, rightly warned “guideline recommendations should indicate the quality of evidence on which they are based and include information about treatment effect size or probability of benefit, the characteristics of the patient group evidence is based on.”(1)
Pophali and Halland, as the reviewers, should have been aware of this prerequisite for the state of the art about Barrett's oesophagus (BE).(2)
Indeed, most recommendations for the care of the patient with BE are based on weak evidence or expert opinion.(3) Among 45 recommendations: a) 12 are rated “conditional”, all but one with low or very low level of evidence; b) 33 are rated “strong” but the level of evidence being high for only 3, moderate for 9 , low or very low level of evidence for the 21 others. Among the 25 recommendations about diagnosis, screening and surveillance only one is rated strong with high level of evidence but it should have been classified with therapy. Despite BE being among the most common conditions encountered by the gastroenterologist, there is very little progress from the 2004 critical review evaluating (from I to V) the evidence concerning 42 statements on clinically relevant issues.(4) The development of new technologies for BE screening (eg. minimally invasive imaging techniques, non-endoscopic devices for cell collection, and biomarkers) requires robust and cooperative international trials, otherwise the next decade could be as the previous, with uncertainty prevailing.
1 McCartney M, Treadwell J, Maskrey N, Lehman R. Making evidence based medicine work for individual patients. BMJ 2016;353:i2452
2 Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ. 2016 May 11;353:i2373.
3 Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG Clinical Guideline: Diagnosis and management of Barrett's Esophagus. Am J Gastroenterol 2016;111:30-50.
4 Sharma P, McQuaid K, Dent J et al.AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop. Gastroenterology 2004;127:310-30.
Competing interests: No competing interests
Where's the CME, why is it happening week after week that it is not available on publication?
Competing interests: No competing interests
Re: Barrett’s oesophagus: diagnosis and management
An excellent review outlining current thinking about diagnosis and management of this important and relatively common condition: of interest to healthcare professionals and patients alike. Initially tempted to recommend the article directly to patients (the 'who' referred to throughout the text), we were discouraged by the complexity of the language used - the SMOG index for the first paragraph is higher than that typical of the Harvard Law Review. Acknowledging that the authors helpfully provided links to sources of information specifically written for patients, we think nonetheless, that the review missed an opportunity to demonstrate simple ways in which the condition could be described and discussed during patient consultations. Perhaps in addition to including a 'What you need to know?' box for doctors, we should also provide an appropriately worded 'What do I need to know?' box for patients.
Competing interests: No competing interests