Snapshot A 50-year-old woman complains of increased regurgitation, especially when lying down. Her father had esophageal cancer at a young age, and she is worried about also having it. She is slightly overweight and has had GERD for the past 3 years. While her PCP makes a note in her file, she reassures the patient that she does meet the requirements for routine screening for esophageal cancer, but the physician will keep an eye out on her GERD. In the meantime, the physician prescribes a proton-pump inhibitor for daily use. 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 intestinal metaplasia Risk factors GERD > 5-10 years 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 Regular endoscopic surveillance to monitor risk of dysplasia and carcinoma Prognosis, Prevention, and Complications Prognosis ↑ lifetime risk of esophageal cancer 5% in men 3% in women ↑ annual risk of esophageal cancer in Barrett esophagus 0.5% - 2.8% per year Complications progression to adenocarcinoma ulceration leading to stricture formation