MKSAP: 55-year-old man with gastroesophageal reflux symptoms

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated for a 6-year history of typical gastroesophageal reflux symptoms treated on an as-needed basis with a proton pump inhibitor. However, the frequency of his reflux symptoms has recently increased and his episodes do not respond to treatment as completely as in the past. An upper endoscopy is scheduled to evaluate the cause of this change in his symptoms. Endoscopy reveals a 4-cm segment of salmon-colored mucosa in the distal esophagus. Biopsy from the salmon-colored segment reveals intestinal metaplasia and goblet cells with no dysplasia. In addition to starting a daily proton pump inhibitor, which of the following is the most appropriate management? A: Daily cyclooxygenase-2 (COX-2) inhibitor therapy B: Endoscopic ablation C: Fundoplication D: Repeat endoscopy in 1 year Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs