A 66-year-old man reports daily heartburn since youth, which he treats with alkalis. An upper endoscopy shows mild erosive esophagitis and displaced squamous columnar junction approximately 7 cm. The esophageal biopsies showed mild erosive esophagitis and a columnar squamous junction displaced approximately 7 cm from the most proximal portion of the gastric folds. Biopsies of the distal esophagus reveal that the normal squamous epithelium has been replaced by intestinal-type columnar epithelium with low-grade dysplasia What is the most appropriate management option for this patient?
This patient presents Barrett's esophagus with low grade dysplasia. I do not like the question, since not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real. In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression. The correct answer is 4.
Given that the esophagitis is mild and the dysplasia is low grade, it is advisable to continue treatment with alkalines.
Indefinite treatment with high doses of PPI since it has been demonstrated that this prevents the progression of Barrett's esophagus to adenocarcinoma, making endoscopic surveillance unnecessary.
Periodic surveillance endoscopies and treatment with PPIs for less than 12 weeks, since prolonged treatment is associated with a high risk of gastrinoma development.
Periodic surveillance endoscopies and indefinite treatment with PPI.
Esophagectomy.
In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression. The correct answer is 4.