GASTROENTEROLOGY ARTICLE OF THE WEEK
June 13, 2002
Spechler SJ. Barrett’s Esophagus. N Engl J Med 2002;346:836-842.
1. Helicobacter pylori and Barrett’s esophagus
a. H. pylori infection should be looked for and eradicated in all patients with Barrett’s
b. H. pylori colonization of the esophagus is associated with increased risk for cancer
c. Eradication of H. pylori correlates with improvement in reflux symptoms
d. Screeing for H. pylori is not recommended in patients with GERD and/or
Barrett’s
2. Subjects with GERD that may benefit from screening endoscopy to diagnose Barrett’s include
a. African American females
b. Obese white men over age 50
c. Presence of GER symptoms for over 5 years
d. Intermittent GER symptoms (less than once weekly) for 2 years
3. Dysplasia in the specialized columnar epithelium
a. may be present as a result of inflammation
b. the finding of low grade dysplasia is highly reproducible between pathologists
c. sampling error is not a major concern in the detection of dysplasia
d. when high grade dysplasia is found, about 1/3 of patients already have an invasive cancer
True or False
4. Adenocarcinoma of the esophagus develops in approximately 0.5% of patients with Barrett’s esophagus per year.
5. Esophagectomy is associated with a 3 to 15% mortality rate and a 30% to 50% rate of postoperative complications.
6. Surveillance endoscopy in patients with Barrett’s and no dysplasia may be performed every 3 to 5 years, others suggest an interval of every 2 to 3 years.
7. The risk of cancer in Barrett’s correlates with the length of Barrett’s epithelium.
8. Up to 40% of patients with esophageal adenocarcinoma have no prior history of GERD.
9. Surveillance endoscopy to detect malignancy in patients with Barrett’s esophagus is effective in prolonging life.
10. Aggressive acid suppression with pH monitoring to abolish all reflux diminishes the risk of malignancy.
11. Current recommendations regarding the treating of patients with Barrett’s esophagus include
a. treat the reflux disease the same as you would a patient with no Barrett’s
b. yearly endoscopic surveillance for patients with no dysplasia
c. repeat EGD in 6 to 12 months if low grade dysplasia found
d. every 3 months endoscopy once high grade dysplasia found for patients who prefer not to
undergo esophagectomy