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
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.GI.15.81) A 45-year-old Caucasian male presents to a gastroenterologist complaining of heartburn and difficulty swallowing. He recalls that he has been told by his primary care physician that he suffers from gastroesophageal reflux disease (GERD). The gastroenterologist decides to perform an upper endoscopy with biopsy. Which of the following findings would be consistent with Barrett's esophagus? QID: 101138 Type & Select Correct Answer 1 Presence of Paneth cells in the lower esophagus 12% (12/99) 2 Metaplasia in the upper esophagus 9% (9/99) 3 A small region of red, velvet-like mucosa in the lower esophagus 76% (75/99) 4 Esophageal varices 1% (1/99) 5 Neutrophilic infiltration 2% (2/99) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.GI.14.70) An esophageal biopsy sample from a 47-year-old male with chronic heartburn reveals intestinal metaplasia. Which of the following abnormal cell types is likely present in this patient’s esophagus: QID: 101127 Type & Select Correct Answer 1 Pseudostratified ciliated columnar epithelium 12% (47/385) 2 Keratinized stratified squamous epithelium 18% (71/385) 3 Simple cuboidal epithelium 16% (61/385) 4 Goblet cells 48% (186/385) 5 Polymorphonuclear leukocytes 1% (5/385) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic