Papadakos SP, Katsaros I, Liatsou E, Argyrou A, Schizas D. Reflux self-medication and limited healthcare consultation: Systemic inadequacies in Barrett’s esophagus screening, surveillance, and management. World J Gastroenterol 2026; 32(31): 117258 [DOI: 10.3748/wjg.117258]
Corresponding Author of This Article
Dimitrios Schizas, PhD, Professor, The First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 17 Agiou Thoma Street, Goudi, Athens 11527, Greece. schizasad@gmail.com
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Gastroenterology & Hepatology
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editorial
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Papadakos SP, Katsaros I, Liatsou E, Argyrou A, Schizas D. Reflux self-medication and limited healthcare consultation: Systemic inadequacies in Barrett’s esophagus screening, surveillance, and management. World J Gastroenterol 2026; 32(31): 117258 [DOI: 10.3748/wjg.117258]
World J Gastroenterol. Aug 21, 2026; 32(31): 117258 Published online Aug 21, 2026. doi: 10.3748/wjg.117258
Reflux self-medication and limited healthcare consultation: Systemic inadequacies in Barrett’s esophagus screening, surveillance, and management
Stavros P Papadakos, Ioannis Katsaros, Efstathia Liatsou, Alexandra Argyrou, Dimitrios Schizas
Stavros P Papadakos, Alexandra Argyrou, The First Academic Department of Gastroenterology, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens 11527, Greece
Ioannis Katsaros, Dimitrios Schizas, The First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens 11527, Greece
Efstathia Liatsou, Department of Surgery, Sahlgrenska University Hospital, Gothenburg 41345, Gothenburg, Sweden
Co-first authors: Stavros P Papadakos and Ioannis Katsaros.
Author contributions: Papadakos SP and Schizas D conceived and designed the overall concept and structure of the manuscript; Papadakos SP, Katsaros I, and Liatsou E performed the literature review and data synthesis; Papadakos SP drafted the initial version of the manuscript; Argyrou A contributed to critical interpretation of the evidence and manuscript editing; Katsaros I and Schizas D critically reviewed the manuscript for important intellectual content and clinical accuracy; Schizas D supervised the work and made the final revisions.
AI contribution statement: ChatGPT was used solely for language polishing and improvement of readability. No part of the scientific content of the manuscript (including the Abstract, Introduction, main text, and Conclusion) was generated by AI. All content was written, critically revised, and approved by the authors. No AI tools were involved in the conceptualization of the manuscript, literature interpretation, or development of the scientific arguments. All authors take full responsibility for the integrity, accuracy, and originality of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Dimitrios Schizas, PhD, Professor, The First Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 17 Agiou Thoma Street, Goudi, Athens 11527, Greece. schizasad@gmail.com
Received: December 3, 2025 Revised: December 30, 2025 Accepted: February 10, 2026 Published online: August 21, 2026 Processing time: 244 Days and 15.7 Hours
Abstract
Huibertse et al recently published a study in World Journal of Gastroenterology, demonstrating that 57.5% of Dutch adults with gastroesophageal reflux symptoms have never consulted a physician, while 36.6% of this unscreened group regularly use over-the-counter acid suppressants and 11.1% already fulfil current European Society of Gastrointestinal Endoscopy criteria for Barrett’s esophagus (BE) screening. Long-term, potent self-medication effectively masks the very symptoms meant to trigger medical consultation, rendering physician-dependent strategies obsolete. This alarming pattern unfolds as obesity - the most powerful modifiable risk factor for erosive reflux, BE, and esophageal adenocarcinoma - continues its unrelenting rise across Europe. Even when BE is eventually diagnosed, surveillance adherence remains inconsistent, particularly in longer segments where neoplastic progression risk is highest. The convergence of widespread self-medication, escalating obesity, low public awareness, and suboptimal surveillance quality exposes the structural failure of current passive, symptom-driven screening models. Reaching this largely unrecognized high-risk group may benefit from enhanced primary-care engagement, appropriate referral for specialist assessment, and the selective use of emerging prediction and non-endoscopic screening tools. Only a population-oriented paradigm will close the widening gap between risk and detection, preventing the next wave of preventable esophageal adenocarcinomas.
Core Tip: Current models for identifying Barrett’s esophagus (BE) rely on patients seeking care for gastroesophageal reflux disease, yet more than half of symptomatic individuals never consult a physician and many mask symptoms with over-the-counter therapy. This creates a largely invisible high-risk population, further amplified by rising obesity and inconsistent surveillance quality. Evidence from population-based studies, registry data, and emerging non-endoscopic tools highlights the need to shift from symptom-driven screening to proactive, risk-based, and system-level strategies to improve BE detection and prevent esophageal adenocarcinoma.
