Snapshot A 52-year-old man presents to the emergency room with chest pain. He denies any pain with physical exertion. He just had a large, fatty, spicy meal. His cardiac work-up is negative. He has had GERD for the past ten years now but recently developed increasing heartburn and regurgitation. His BMI is 31 kg/m2. His emergency room physician recommends that he continue using proton pump inhibitors and schedules an outpatient primary care appointment for him. In a note to his PCP, he suggests a screening endoscopy. Introduction Metaplastic transformation of esophageal lining normal squamous epithelium → columnar epithelium → intestinal metaplasia (with globlet cells) Result of chronic gastroesophageal reflux disease (GERD) Pathogenesis mucosal injury causes acute and chronic inflammatory change esophageal stem cells develop columnar metaplasia Risk factors GERD > 5-10 years 10% incidence of Barrett esophagus in GERD patients age > 50 years male > female obesity Associated conditions risk of progression to adenocarcinoma Presentation Symptoms heartburn regurgitation Physical exam typically normal Evaluation Diagnosis with upper endoscopy with biopsy showing both histology metaplastic columnar epithelium with goblet cells (normally in stomach and intestines) in esophageal mucosa visualization of abnormal distal esophageal mucosa Differential Diagnosis Erosive esophagitis Gastritis Treatment Lifestyle modifications weight loss elevate head of bed Proton pump inhibitor for GERD Endoscopic surveillance absence of dysplasia repeat endoscopy in 3-5 years low-grade dysplasia repeat endoscopy in 6-12 months most experts prefer eradication therapy with radiofrequency ablation Surgical intervention for prevention of cancer with unclear benefits Prognosis, Prevention, and Complications Prognosis ↑ lifetime risk of esophageal cancer 5% in men 3% in women ↑ annual risk of esophageal cancer in Barrett's esophagus 0.5% - 2.8% per year Complications progression to adenocarcinoma ulceration leading to stricture formation
QUESTIONS 1 of 2 1 2 Previous Next (M2.GI.16.4694) A 46-year-old overweight male presents to his primary care physician for an annual checkup. He has a history of gastroesophageal reflux disease (GERD) with biopsy confirming Barrett's esophagus on therapy with omeprazole. Review of systems is unremarkable, and the patient is otherwise doing well. Vitals are within normal limits and stable. The patient asks about the need for continuing his omeprazole therapy. You recommend he continue his medication because of which of the following most probable long-term sequelae associated with Barrett's esophagus? QID: 107751 Type & Select Correct Answer 1 Adenocarcinoma 80% (4/5) 2 Squamous cell carcinoma (SCC) 0% (0/5) 3 Transitional cell carcinoma 20% (1/5) 4 Gastro-intestinal stromal tumor (GIST) 0% (0/5) 5 MALT lymphoma 0% (0/5) M 8 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK