Complications gastroesophageal reflux disease

(Gastro 2020;158:760)

• Reflux esophagitis (erosions/ulcers above GE jxn), strictures (caused by chronic inflamm)

• Barrett esophagus. (BE):

• Screen if chronic (>5 y) and/or frequent GERD (≥1/wk) in ♂ w/ ≥2 risk factor for Barrett’s/esophageal adeno:

  • when > 50 y,
  • white,
  • hiatal hernia,
  • central adiposity,
  • smoking,
  • FHx of Barrett’s/esophageal adeno.
  • In ♀, consider only if multiple RFs. 0.1-0.3%/y risk of esoph adenocarcinoma, ↑ if ↑ dysplasia (Am J Gastro 2016;111:30).

• Mgmt:

  • PPI.
  • W/o dysplasia: surveillance EGD q3-5y.
  • Low-grade dysplasia: EGD q12mo; possible endoscopic eradication.
  • High-grade dysplasia: endoscopic eradication; consider chemoprophylaxis w/ high-dose PPI & ASA (Lancet 2018;392:400).