Virtual Clinic – The patient with Barretts
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.
References
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.
