OnExamination MRCP Part 1 (Updated Feb 2023)

This time, after an acute episode of dyspepsia and abdominal pain, he underwent an upper GI endoscopy which showed Barret’s esophagus. Histopathology showed very low-grade dysplasia. What is the best next line of management?   Endoscopic ablation therapy    A trial of PPI therapy   Endoscopic mucosal resection   Lower esophageal resection   Only observation   Key learning points Barret’s esophagus is treated with PPI as first line therapy. Explanation Barret’s oesophagus occurs due to gastro-oesophagal reflux disease. The initial therapy for this condition is PPI-based. Usually, once-daily dosing of PPI is preferred. Observation only is not a preferred strategy. Barret’s oesophagus is a premalignant condition. Hence, quick intervention is needed. The three remaining therapies are used in the NICE pathways in patients with moderate to severe grade dysplasia. Also, if there is inadequate response to PPI therapy, then these modalities of treatment may be tried. They are also used for recurrent disease.