ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two) | April 2023-GERD and Barretts Esophagus and Endotherapy

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This document provides an overview of GERD (gastroesophageal reflux disease), Barrett's esophagus, and Barrett's endotherapy. GERD is a common condition characterized by symptoms such as heartburn, regurgitation, and dysphagia. It affects 10-20% of the population, with equal prevalence in males and females. The document discusses the pathophysiology of GERD, its symptomatology, and the diagnosis through methods like pH testing and endoscopy.<br /><br />Treatment options for GERD include lifestyle modifications, such as weight loss and avoiding trigger foods, and medication, such as proton pump inhibitors (PPIs). However, if medical management fails or there are complications, surgical interventions like fundoplication or sphincter augmentation may be considered.<br /><br />Barrett's esophagus is a precancerous condition that develops in a small percentage of people with chronic GERD. Annual risk of progression to esophageal adenocarcinoma is around 0.3%. Risk factors for Barrett's esophagus include chronic GERD symptoms, age over 50, male gender, tobacco usage, obesity, and Caucasian race. Diagnosis is confirmed by endoscopy, and surveillance is required for certain patient groups.<br /><br />The document also discusses endoscopic eradication therapy for Barrett's esophagus, which includes techniques like endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), and cryotherapy. These treatments aim to destroy dysplastic Barrett's tissue and promote the regeneration of normal esophageal tissue. The appropriate therapy depends on factors such as the presence and grade of dysplasia, lesion size, and patient factors like comorbidities and preferences.<br /><br />Complications of Barrett's endotherapy include intraprocedural and post-procedural complications such as bleeding, perforation, chest pain, delayed perforation, and stricture formation. The document highlights the importance of a multidisciplinary team approach involving experienced endoscopists, thoracic surgeons, and GI pathologists.<br /><br />In summary, this document provides a comprehensive overview of GERD, Barrett's esophagus, and Barrett's endotherapy, including their presentation, diagnosis, management, and potential complications. It emphasizes the importance of early diagnosis, appropriate treatment selection, and long-term surveillance to prevent the progression to esophageal adenocarcinoma.

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Vivek Kaul, MD, FASGE

Keywords

GERD

gastroesophageal reflux disease

Barrett's esophagus

Barrett's endotherapy

heartburn

regurgitation

dysphagia

pH testing

endoscopy

proton pump inhibitors