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.
I am continuing to feel well. I take omeprazole, 20 mg, either 1 or 2 a day with good control of my symptoms. I have not needed to make any further modifications in my diet and can continue to eat many of the foods on the typical sin list without difficulty. I do continue to notice that certain spices are bothersome. I have decided along with my physician to continue with yearly endoscopies as I am most comfortable with this regimen.
I last saw Mrs J about a year ago. She was doing well at that time and remained on the omeprazole, 20 mg, 1 or 2 tablets daily. She has had endoscopy annually in December 2002, 2003, and 2004. The biopsies have all been consistent with Barrett esophagus, though no dysplasia has been seen. I plan to continue with a regimen of omeprazole, 20 mg, 1 or 2 tablets daily and endoscopy every year as that is the patient's preference.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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The Rational Clinical Examination Barrett esophagus and gastric and esophageal cancers are less common but important diagnoses....
The Rational Clinical Examination Table 69-1 Prevalence of Endoscopic Diagnoses in Patients With Dyspepsia2
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