Patients <55yr with Reflux symptoms account for a heavy burden on endoscopy, yet significant endoscopic findings are rare: most have functional heartburn and may be managed without investigation. Oesophageal adenocarcinoma (OAC) and precursor Barrett’s oesophagus (BO) are also uncommon hence selective screening is not recommended. However epidemiological studies show increasing incidence of OAC in younger patients often being diagnosed at a later stage.  Less invasive tests that identify those younger patients at increased risk of BO/OAC and reassure most patients and referrers without endoscopy are needed. Capsule sponge testing (CS) was introduced in UK national studies with outcomes showing feasibility acceptability and efficacy in detecting BO, reduction in endoscopy and lower costs. Details by age group are not published.

This prospective cohort study of patients routinely referred with reflux symptoms to a single UK non-specialist hospital 2020-2023. Patients were offered CS oesophageal cell sampling as part of an early diagnosis pathway. Detailed methods previously published.¹Only patients with abnormal CS, inadequate samples or ongoing symptoms after treatment advice were offered endoscopy. Records were review in all patients >=1y follow-up. Endoscopic histology yield of BO were recorded in patient categories of younger (<50y male/65 female) and older (>=50 male/65y female) according to previous modelling. Detailed analysis of the younger age group is presented.

871 patients (median age 54 years) were offered CS of which 572 (65.7%) were in the younger age group.  Abnormal results (TFF3, atypia, p53) were found in 48/507(9.5%) adequate CS tests, with all 48 having subsequent endoscopy. 65 (11.4%) had failed or inadequate CS of whom 49 had subsequent endoscopy (16 declined). 115 patients (20.1%) with normal CS went on to endoscopy due to persistent symptoms. Older age group shown for comparison but not described further here. 11 younger patients were offered surveillance based on current BSG guidelines: 5 having long segments maximal extent>=4cm. 1 had indefinite for dysplasia.

Atrophic gastritis was also found in 4/212 patients in the young cohort and 6/119 in the older cohort. 360/572 (63%) patients in the younger and 180/299 (60.2%) in the older cohort avoided gastroscopy- median follow up 27.2 months.

Histology on patients going on to endoscopy by Age Category

^{* p=.005 Chi Sq=7.85}

A low overall presumed incidence of BO in younger lower risk cohort is as expected (3.67%), but the yield of histologically confirmed BO is greatly enhanced by using CS triage to 9.9% whilst avoiding endoscopy in 63% patients. A significantly increased yield to 21% is found in older cohorts. This demonstrates the value of a CS pathway in managing younger patients (as well as older) presenting with chronic reflux and may also potentially be valuable in primary care. It can provide prompt reassurance whilst detecting the small number of patients with significant disease and is resource-saving.