A 54-Year-Old Man Is Evaluated for Worsening Upper Abdominal Discomfort

A 54-year-old man is evaluated for worsening upper abdominal discomfort and heartburn.  For the last 5 years, his occasional midepigastric pain after meals and at night was relieved by over-the-counter ranitidine.  Over the last 6 months, the patient's symptoms have occurred almost daily and are not relieved by ranitidine.  He has had no dysphagia, odynophagia, hematemesis, melena, or weight loss.  He has a 40-pack-year smoking history.
Vital signs are within normal limits.  BMI is 29 kg/m².  The abdomen is soft and nontender.  Stool occult blood testing is negative.
Upper gastrointestinal endoscopy shows moderate esophagitis with red, velvety mucosa extending from the gastroesophageal junction into the distal esophagus.  There is a moderate hiatal hernia but no erythema or ulcers in the stomach or duodenum.  Biopsy shows Barrett esophagus with high-grade dysplasia.
In addition to daily proton pump inhibitor therapy, which of the following is the best next step in management of this patient?

A) Empiric Helicobacter pylori treatment
B) Endoscopic ablation therapy
C) Endoscopy surveillance in 6-12 months
D) Referral for surgical fundoplication
E) Repeat endoscopy in 3-5 years

Correct Answer:

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