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Demo Question

A 39-year-old sailor has had repeated visits to his GP for heartburn and dyspepsia. He had been an irregular visitor and his treatments had been discontinuous in the past.

This time, after an acute episode of dyspepsia and abdominal pain, he underwent an upper GI endoscopy which showed Barret's oesophagus. Histopathology showed very low-grade dysplasia.

What is the best next line of management?

  Endoscopic ablation therapy
   A trial of PPI therapy
  Endoscopic mucosal resection
  Lower oesophageal resection
  Only observation

Key learning points

Barret’s oesophagus is treated with PPI as first line therapy. 

Explanation

Barret's oesophagus occurs due to gastroesophagal reflux disease. The initial therapy for this condition is PPI-based. Usually, once-daily dosing of PPI is preferred.

Observation only is not a preferred strategy. Barret's oesophagus is a premalignant condition. Hence, quick intervention is needed.

The three remaining therapies are used in the NICE pathways in patients with moderate to severe grade dysplasia. Also, if there is inadequate response to PPI therapy, then these modalities of treatment may be tried. They are also used for recurrent disease.

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Customer Reviews

Based on 13 reviews
92%
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A
Amish

Good value with coupons

J
James T
Excellent source

Great revision source for MRCP 1

o
omer ahmed

Nice source

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