Medical Surgical GERD #3

Question

Following an endoscopy, the client is told they have Barrett’s esophagus without dysplasia due to uncontrolled gastroesophageal reflux disease. Which is the priority for this client?

Answers

  1. Endoscopic resection
    • Rationale:

      This answer is not correct because an endoscopic resection is not indicated because there are no precancerous or cancerous cells. Therefore, medications, including proton pump inhibitors, and lifestyle changes are indicated to minimize the risk of dysplasia from damage caused by gastric acid on the esophagus.

  2. Immediate cryotherapy procedure
    • Rationale:

      This answer is not correct because cryotherapy, a procedure to freeze abnormal cells, is not indicated for Barrett’s esophagus without dysplasia. “Without dysplasia” means there are no precancerous changes found in the cells. Therefore, medications, including proton pump inhibitors, and lifestyle changes are indicated to minimize the risk of dysplasia from damage caused by gastric acid on the esophagus.

  3. One-month endoscopic followup
    • Rationale:

      This answer is not correct because a one-month follow up endoscopic exam is not indicated for Barrett’s esophagus without dysplasia. “Without dysplasia” means there are no precancerous changes found in the cells. Therefore, medications, including proton pump inhibitors, and lifestyle changes are indicated to minimize the risk of dysplasia from damage caused by gastric acid on the esophagus.

  4. Proton pump inhibitors treatment
    • Rationale:

      This answer is correct because medications and lifestyle changes are indicated to minimize the risk of dysplasia from damage caused by gastric acid on the esophagus. Medications include use of proton pump inhibitors or H2 blocking agents. Lifestyle changes include decreasing weight, especially if truncal obesity is present, stop smoking and drinking alcohol, and avoiding aggravating agents, such as NSAIDs, chocolate, tea, spicy foods, and laying down immediately after eating.

Overview

The priority action of the client diagnosed with Barrett’s esophagus without dysplasia due to uncontrolled gastroesophageal reflux disease (GERD) is to control GERD symptoms. Actions to control GERD symptoms include taking prescribed medications and making lifestyle changes.

Explanation

Learning Outcomes

Barrett’s esophagus is a condition that can occur due to persistent exposure of the esophageal tissue to stomach acid. The usual smooth pink lining of the esophagus becomes irritated and damaged, which causes the esophageal lining to become thick and red. The continuous exposure to acid can make the esophagus have dysplasia, precancerous cellular changes that lead to esophageal cancer. There are various stages of Barrett’s esophagus and are identified through endoscopic examination and tissue sampling. These stages include non-dysplastic (without cancerous tissue), low-grade dysplasia (slight cellular changes discovered), high-grade dysplasia (more extensive cellular changes discovered, but not cancer yet), noninvasive cancer discovered, and invasive cancer discovered.

Test Taking Tip

Be sure to review the stages of Barrett’s esophagus and understand the term, “dysplasia”.

Video Rationale