{
  "abstract": "Background Young adults form most reflux referrals, yet significant endoscopic findings are uncommon and functional heartburn predominates. Although Barrett’s oesophagus (BO) and oesophageal adenocarcinoma (OA) are less prevalent in younger adults, OA incidence is rising and often diagnosed late in this group. Current guidelines do not recommend screening <50 years. Capsule sponge (CS) testing detecting trefoil factor 3 (TFF3) offers a minimally invasive triage tool to identify BO and reduce unnecessary endoscopy. Agestratified data in younger patients remain limited.Methods Two datasets were analysed. In 2 combined national cohorts (England/Scotland, 10/2020–11/2025), reflux patients were offered CS testing. Samples underwent central TFF3, p53 and H&E analysis by CYTED Health; equivocal tests were excluded. Endoscopy outcomes were not accessed. A second prospective cohort (single U.K. hospital, 2020–2023) included patients with >1year followup. Endoscopy and histology were recorded. BO yield was compared between younger (<50y male/<65y female) and older (≥50y male/≥65y female) groups based on BEST4 study modelling. Endoscopy was only offered to abnormal/inadequate CS or persistent symptoms after treatment.Results In the national cohorts, of 7922 CS samples processed 7248 (91.5%) were adequate. Of these, 4581 (63.2%) were ≥50y and 2667 (36.8%) <50y. TFF3 positivity was significantly higher in older patients (651/4,413; 14.8%) than younger (136/2,609; 5.2%) p<.00001. Overall positivity was 11.2% (787/7022), with 17.3% of positives occurring <50y.In the prospective cohort, 871 patients (median age 54) were offered CS; 572 (65.7%) were younger. Among younger patients, abnormal CS occurred in 48/507 (9.5%). Of 65 inadequate CS, 49 had endoscopy. 115 patients with normal CS were scoped for persistent symptoms. 11(1.9%) younger patients and 9 (3%) older entered BO surveillance; 5 younger patients had longsegment BO (≥4 cm) 1 had indefinite dysplasia.Conclusions These large datasets confirm known lower BO incidence in younger adults but show nearly one in six TFF3+ve cases occurred <50y in the National cohorts. In the prospective cohort, presumed BO incidence in younger adults was low 21/572 (3.7%), yet CS triage increased BO yield to 9.9% in younger and 21% in older patients while avoiding endoscopy in 63% overall. Notably 21/46 (46%) of new BO diagnoses were in younger adults. Implementing strict age-based endoscopy only pathways risk missing clinically relevant disease. CS testing is an effective, scalable triage strategy for reflux pathways and supports reconsideration of agebased thresholds, particularly in patients with additional risk factors.Abstract FP32 Table 1BO/OA Yield in reflux patients by endoscopy indication (n=331)Endoscopy IndicationBO <50y M/<65y FBO ≥50y M/≥65y FAbnormal CS19/48 (37.5%)18/37 (48.6%) incl 1 OAInadequate CS1/49 (2.0%)2/34 (5.9%)Negative CS + persistent symptoms1/115 (0.9%)2/48 (4.1%)Overall yield21/212 (9.9%)25/119 (21.0%)*p=.005, Chi Sq=7.85",
  "authors": [
    {
      "affiliations": [
        "East and North Herts NHS Teaching Trust, Stevenage, United Kingdom"
      ],
      "name": "Rohith Kumar"
    },
    {
      "affiliations": [
        "East and North Herts NHS Teaching Trust, Stevenage, United Kingdom"
      ],
      "name": "Danielle Morris"
    }
  ],
  "title": "FP32 How can barrett’s oesophagus be identified in younger patients? Real-world data using capsule sponge in national and prospective cohort studies",
  "uid": "5faead3b-3cc7-5989-bc04-3b21fc73a57b"
}