Choose how you want to revise
Revise with my preferences. Choose your difficulty or recap questions you've found hard.
Test myself against recent exam themes and ones curated by BMJ’s editorial team of doctors.
Play under a username and join friends or others for 10 questions. Move up of the daily leaderboard.
On the go
Download the app for offline access. Make revision easily fit into your schedule.
Select the best subscription for your exam date
Join 200,000+ OnExamination users who have successfully become medical professionals
January 2024 Exam
April 2024 Exam
August 2024 Exam
Revise with quality questions and detailed explanations
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 esophagus. 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 esophageal resection
Key learning points
Barret’s esophagus is treated with PPI as first line therapy.
Barret's oesophagus occurs due to gastro-oesophagal 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.