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Screening and Rx in Barrett Esophagus
Societal recommendations include surveillance esophagogastroduodenoscopy every 3 to 5 years for patients with Barrett esophagus, and proton pump inhibitor therapy for symptom control.
A 42-year-old man with chronic GERD symptoms undergoes an upper endoscopy, which demonstrates salmon-colored tongues that extend 2 cm above the squamocolumnar junction. Biopsies reveal intestinal metaplasia without any dysplasia. Which of the following would you recommend?
a. Ablative therapy for the Barrett tissue
b. Continue proton pump inhibitors; no further endoscopy required
c. Surveillance EGD every 3 years
d. Refer for a Nissen fundoplication
ANSWER: C
Biopsies reveal that this patient has intestinal metaplasia, which confirms the diagnosis of Barrett esophagus. Importantly, biopsy reveals that he has no dysplasia. Therefore, societal recommendations include surveillance esophagogastroduodenoscopy every 3 to 5 years. He should also continue proton pump inhibitors for symptom control. There is no evidence to support ablative therapies for non-dysplastic Barrett esophagus. A fundoplication would not reverse the endoscopic changes of Barrett esophagus.
Clinical Tips for Using Antibiotics and Corticosteroids in IBD
January 5th 2013The goals of therapy for patients with inflammatory bowel disorder include inducing and maintaining a steroid-free remission, preventing and treating the complications of the disease, minimizing treatment toxicity, achieving mucosal healing, and enhancing quality of life.
