Clinical Crossroads | Clinician's Corner

A 59-Year-Old Woman With Gastroesophageal Reflux Disease and Barrett Esophagus

Stuart Jon Spechler, MD, Discussant
JAMA. 2003;289(4):466-475. doi:10.1001/jama.289.4.466.
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DR BURNS: Mrs J is a 59-year-old woman with a long history of gastroesophageal reflux disease (GERD) and documented Barrett esophagus. She lives near Boston with her husband and has 2 grown children. She sees her primary care physician, Dr W, and she has managed care insurance.

Mrs J initially developed symptoms of heartburn in the early 1990s and was prescribed ranitidine, 150 mg/d, which was later increased to twice daily without improvement. In 1993, Mrs J underwent an upper GI series, the results of which were normal; in 1994, test results for Helicobacter pylori were negative.

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Figure 1. Endoscopic View of Barrett Esophagus
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Note the red, metaplastic epithelium extending well above the gastroesophageal junction.
Figure 2. Low-Grade Dysplasia in Barrett Esophagus
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The nuclei of the dysplastic cells are enlarged, hyperchromatic, and crowded, and these changes involve the surface cells as well as the cells of the glands. The abnormal cells remain confined within the basement membrane of their glands (hematoxylin-eosin, original magnification × 25). Photomicrograph provided by Edward Lee, MD.



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