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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.