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Clinical Crossroads Update
November 1, 2006

A 59-Year-Old Woman With Gastroesophageal Reflux Disease and Barrett Esophagus, 4 Years Later

JAMA. 2006;296(17):2140. doi:10.1001/jama.296.17.2140

In October 2002, at Medicine Grand Rounds, Stuart Spechler, MD, discussed care for a 59-year-old woman with gastroesophageal reflux disease (GERD) and Barrett esophagus.1 Mrs J had a long history of GERD and documented Barrett esophagus. At that time her symptoms were well controlled with omeprazole (20 mg/d) and she was undergoing yearly endoscopy for surveillance. Mrs J and her physician wondered whether she needed yearly endoscopy or whether her risk of esophageal cancer is lessening given a series of recent endoscopies without evidence of dysplasia on biopsy. Dr Spechler discussed the epidemiology, initial evaluation, and medical and surgical treatment of GERD. He also reviewed management recommendations for patients with Barrett esophagus. He recommended that Mrs J continue indefinitely with coventional-dose proton pump inhibitor therapy that has controlled her GERD symptoms. He reassured her that her risk of developing esophageal cancer is small, no more than 0.5% per year. Nevertheless, he did recommend continued regular endoscopic surveillance at an interval of every 3 years.