Barrett's esophagus (intestinal metaplasia of the distal esophagus with goblet cells on b...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-BARRETTS-ESOPHAGUS-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-ESOPHAGEAL`
Sources	`SRC-ESMO-ESOPHAGEAL-2024` `SRC-NCCN-ESOPHAGEAL-2025`

Red Flag Origin

Definition	Barrett's esophagus (intestinal metaplasia of the distal esophagus with goblet cells on biopsy after EGD performed for chronic GERD or Barrett's-specific surveillance) in an individual without a current esophageal adenocarcinoma diagnosis. Established precursor lesion to esophageal adenocarcinoma — annual progression rates: non-dysplastic Barrett's ~0.1-0.3%/year to EAC, low-grade dysplasia (LGD) ~0.7-2%/year, high-grade dysplasia (HGD) ~7-19%/year. Endoscopic surveillance and endoscopic eradication therapy (radiofrequency ablation, endoscopic mucosal resection) for dysplastic Barrett's substantially reduce EAC incidence and mortality. Prevention-persona RedFlag (§20 ratification 2026-05-18, v0.3 chronic-condition pilot).
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "barretts_esophagus_diagnosis_confirmed",
      "value": true
    },
    {
      "finding": "barretts_esophagus_with_dysplasia_low_grade",
      "value": true
    },
    {
      "finding": "barretts_esophagus_with_dysplasia_high_grade",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 chronic-condition prevention pilot — Barrett's esophagus. Prevention-persona RedFlag (CHARTER §3 amended 2026-05-18 Path A, HCP-mediated). Fires when patient profile shows confirmed Barrett's esophagus (with or without dysplasia) AND no confirmed esophageal adenocarcinoma. Engine routes such patients to a PreventionPlan with 2 tracks: intensified EGD surveillance per ACG/NCCN cadences (IND-BARRETTS-ESOPHAGUS-PREVENTION-SURVEILLANCE) as the standard pathway; routine q5y EGD observation (IND-BARRETTS-ESOPHAGUS- PREVENTION-OBSERVATION) as the alternative — appropriate ONLY for confirmed non-dysplastic Barrett, not for any dysplasia grade. Evidence for surveillance + endoscopic eradication therapy reducing EAC incidence: HGD ablation reduces progression to EAC by ~75% vs observation (Shaheen et al. JAMA 2014; AIM-Dysplasia trial). LGD ablation reduces progression to HGD/EAC by ~75% (SURF trial, Phoa et al. JAMA 2014). For non-dysplastic Barrett, surveillance does not reduce incidence but improves earliest-stage detection. Dysplasia management: LGD → endoscopic eradication therapy (RFA ± EMR for visible lesions) OR intensified surveillance q6-12mo if patient declines. HGD → endosc...

Used By

Indications

IND-ACHALASIA-ESOPHAGEAL-PREVENTION-SURVEILLANCE - IND-ACHALASIA-ESOPHAGEAL-PREVENTION-SURVEILLANCE
IND-BARRETTS-ESOPHAGUS-PREVENTION-OBSERVATION - IND-BARRETTS-ESOPHAGUS-PREVENTION-OBSERVATION
IND-BARRETTS-ESOPHAGUS-PREVENTION-SURVEILLANCE - IND-BARRETTS-ESOPHAGUS-PREVENTION-SURVEILLANCE

Red flag

RF-ACHALASIA-ESOPHAGEAL-PREVENTION - Achalasia (primary esophageal motor disorder with impaired LES relaxation and loss of eso...