Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man is evaluated in follow-up for heartburn of 7 years’ duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette smoking and continues to smoke.
On physical examination, vital signs are normal; BMI is 29. The remainder of the physical examination is normal.
He is concerned about his long-term heartburn symptoms and expresses an interest in further evaluation to assess his risk of cancer because of his prolonged symptoms. Based on his risk factors and after discussing with the patient the benefits and harms of screening endoscopy for Barrett esophagus, upper endoscopy is performed. An area of salmon-colored mucosa is seen in the esophagus, and biopsies confirm Barrett esophagus without dysplasia.
Which of the following is the most appropriate next step in management?
A. Endoscopic ablation
B. Esophagectomy
C. Fundoplication
D. Repeat upper endoscopy in 3 to 5 years
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