Your next patient in clinic is a 54-year-old man. The referral letter is as below:
Thank you for seeing this 54-year-old man who has a 3-year history of GORD, which has worsened and become less responsive to PPIs in the last 2-3 months. He reports heartburn, nausea and epigastric pain. He has a body mass index (BMI) of 29 and is otherwise fit and healthy. He does not drink but is a smoker (20 pack years). There is no family history of note. I have tested for Helicobacter pylori – this has come back negative. His blood tests are normal with no evidence of anaemia. I would be grateful for your assessment.
Bennett, C., Vakil, N., Bergman, J., Harrison, R., Odze, R., Vieth, M., Sanders, S., Gay, L., Pech, O., Longcroft–Wheaton, G. and Romero, Y., 2012. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology, 143(2), pp.336-346.
Di Pietro, M. and Fitzgerald, R.C., 2018. Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett’s oesophagus with low-grade dysplasia. Gut, 67(2), pp.392-393.
Duits, L.C., Phoa, K.N., Curvers, W.L., Ten Kate, F.J., Meijer, G.A., Seldenrijk, C.A., Offerhaus, G.J., Visser, M., Meijer, S.L., Krishnadath, K.K. and Tijssen, J.G., 2015. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut, 64(5), pp.700-706.
Fitzgerald, R.C., Di Pietro, M., Ragunath, K., Ang, Y., Kang, J.Y., Watson, P., Trudgill, N., Patel, P., Kaye, P.V., Sanders, S. and O’Donovan, M., 2014. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut, 63(1), pp.7-42.
Januszewicz, W. and Fitzgerald, R.C., 2019. Barrett’s oesophagus and oesophageal adenocarcinoma. Medicine, 47(5), pp.275-285.
Peters, F.T.M., Ganesh, S., Kuipers, E.J., Sluiter, W.J., Klinkenberg-Knol, E.C., Lamers, C.B.H.W. and Kleibeuker, J.H., 1999. Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study. Gut, 45(4), pp.489-494.
Phoa, K., van Vilsteren, F., Weusten, B., Bisschops, R., Schoon, E., Ragunath, K., Fullarton, G., Di Pietro, M., Ravi, N., Visser, M., Offerhaus, J., Seldenrijk, N., Meijer, S., ten Kate, F., Tijssen, J., Bergman, J. (2014) Radiofrequency ablation versus endoscopic surveillance for patients with Barrett’s oesophagus and low-grade dysplasia JAMA 311(12) pp. 1209-1217
Shaheen, N.J., Falk, G.W., Iyer, P.G. and Gerson, L.B., 2016. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Official journal of the American College of Gastroenterology| ACG, 111(1), pp.30-50
Waterhouse, D.J., Fitzpatrick, C.R., di Pietro, M. and Bohndiek, S.E., 2018. Emerging optical methods for endoscopic surveillance of Barrett’s oesophagus. The Lancet Gastroenterology & Hepatology, 3(5), pp.349-362.
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The patient has had a direct access endoscopy. The UGI endoscopy shows an area of columnar mucosa in the lower oesophagus between 33 and 35cm from the incisors (see below). Biopsies taken from this area are reported as showing intestinal metaplasia. The patient has been referred to clinic to discuss the findings.
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What is the likely diagnosis here?CorrectIncorrect
There are several recognised risk factors for the development of BO. These include (tick all that apply):CorrectIncorrect
At endoscopy, it is important to document the extent of the disease as this, along with histology, will guide the need for treatment and surveillance interval. Which of the following is the correct endoscopic classification system for BO:CorrectIncorrect
As BO predisposes patients to the development of oesophageal cancer, surveillance endoscopy plays an important role in the detection of progression to oesophageal cancer. What is the annual cancer risk in those with non-dysplastic ((i.e.. no evidence of low- or high-grade dysplasia) BO?CorrectIncorrect
Reviewing the patient’s endoscopy and histology report, you note that the Prague classification is C1M2, and the histology report states ‘Barratt’s oesophagus with intestinal metaplasia’.
The patient asks you how frequently he will need to have surveillance endoscopy. You advise him he will need to have surveillance endoscopy:CorrectIncorrect
The patient asks if there is anything that he can do to reduce the risk of progression to oesophageal cancer. You discuss non-pharmacological management strategies for GORD, and you also discuss pharmacological management.
Which of the following are medications does the BSG recommend for symptoms control in BO (select all that apply):CorrectIncorrect
The patient returns to see you after his surveillance gastroscopy in 3 years’ time. The endoscopy and histology demonstrate low-grade dysplasia.
According to the BSG, what are the next steps likely to be in this case?CorrectIncorrect