A 52-Year-Old Man Is Being Evaluated Due to Upper Abdominal

A 52-year-old man is being evaluated due to upper abdominal discomfort, nausea, and frequent heartburn for the past 6 months.  His symptoms are partially relieved with over-the-counter antacids.  The patient has had no chest pain, dysphagia, odynophagia, vomiting, black or bloody stools, or weight loss.  He has a history of hypertension and mild intermittent asthma.  He has a 20-pack-year smoking history but quit 3 years ago.  BMI is 32.8 kg/m².  Upper gastrointestinal endoscopy shows moderate esophagitis with velvety, reddish mucosa extending from the gastroesophageal junction into the distal esophagus and mild antral gastritis.  Biopsy results are consistent with Barrett esophagus without dysplasia.  Antral mucosal biopsies do not show evidence of Helicobacter pylori infection.  He is started on proton pump inhibitor therapy.  Which of the following is the best next step in management of this patient?

A) Endoscopic ablative therapy
B) Laparoscopic fundoplication
C) Repeat endoscopy in 3-5 years
D) Repeat Helicobacter pylori testing in 8 weeks
E) Surgical esophagectomy

Correct Answer:

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