A favorite topic of boards is GERD and the development of Barrett esophagus. GERD
is caused by a decrease in the physiologic antireflux barriers at the GE junction,
resulting in gastric contents being released in to the esophagus. Surprisingly, the major
cause of GERD is not hypersecretion of gastric contents, but rather an inappropriate
relaxation of the lower esophageal sphincter.
Remember:
o A 4-week empiric trial of a PPI has a high sensitivity for the diagnosis of GERD
o Patients presenting with weight loss, dysphagia, odynophagia, or those whose
symptoms are refractory to medical therapy should undergo further testing
o Ambulatory esophageal pH monitoring is the most accurate means to confirm
the diagnosis of GERD
The development of Barrett esophagus is a feared complication of GERD due to the
increased risk for esophageal adenocarcinoma (remember, squamous cell carcinoma
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arises in the upper portion of the esophagus and adenocarcinoma arises distally, closer
to the GE junction).
Remember:
o Histologically, Barrett esophagus has specialized intestinal metaplasia with
mucin containing goblet cells
o Dysplasia found during EGD:
none -> surveillance EGD should be repeated in 1 year, then every 5
years if negative
low grade -> surveillance in 6 months for 1 year, then yearly
high grade -> surveillance every 3 months for focal dysplasia vs. surgical
or endoscopic management for multifocal dysplasia