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.