ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day Two) | March 2026-GERD and Barrett’s: Diagnosis and Endoscopic Therapy

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This document reviews gastroesophageal reflux disease (GERD), Barrett’s esophagus, and endoscopic therapy for dysplastic Barrett’s. GERD affects ~10–20% of Western populations weekly and reduces quality of life (sleep and work productivity). Typical GERD symptoms are heartburn and regurgitation; extraesophageal/atypical symptoms include cough, hoarseness, throat clearing, asthma, and non-cardiac chest pain. GERD can lead to complications such as strictures, Schatzki ring, bleeding/iron deficiency, Barrett’s esophagus, and esophageal adenocarcinoma (EAC).<br /><br />Evaluation emphasizes when to perform upper endoscopy: empiric therapy is reasonable for typical symptoms without alarm features, but endoscopy is warranted with alarm symptoms (bleeding, dysphagia, weight loss, chest pain, mass) or refractory/longstanding symptoms (often age ≥50). Severe erosive esophagitis (LA grade C/D) should prompt repeat EGD after 8–12 weeks of twice-daily PPI to exclude Barrett’s. Diagnostic confirmation can follow the Lyon Consensus (LA C/D esophagitis, long-segment Barrett’s, or acid exposure time >6% on pH testing). Ambulatory reflux testing includes Bravo (off acid suppression) and pH-impedance (on therapy to assess acid and non-acid reflux). For isolated extraesophageal symptoms without typical GERD, reflux monitoring is recommended before a PPI trial.<br /><br />Management includes lifestyle measures and acid suppression (PPIs taken 30–60 minutes before meals). PPIs outperform H2 blockers for healing and symptom control; NERD may use on-demand therapy, while erosive disease often recurs off PPI. Long-term PPI use should be at the lowest effective dose; suggested periodic labs include creatinine, magnesium, B12, and CBC. Antireflux surgery works best in patients with typical symptoms, PPI response, and abnormal pH testing, but many resume medications long term and may have side effects (dysphagia, gas-bloat, inability to vomit).<br /><br />Barrett’s esophagus is defined as ≥1 cm of salmon-colored mucosa above the GE junction with biopsy-proven intestinal metaplasia; it is often asymptomatic and associated with GERD. Risk of progression to EAC rises with dysplasia (lowest in non-dysplastic BE, highest in high-grade dysplasia). Screening is suggested for selected at-risk patients (chronic GERD plus multiple risk factors such as age ≥50, male sex, White race, obesity, smoking, and family history). Dysplasia should be confirmed by expert pathology.<br /><br />Barrett’s endoscopic therapy aims for complete eradication of intestinal metaplasia (CRIM), typically using EMR/ESD for nodular disease and RFA, cryotherapy, or hybrid APC for flat dysplasia. Recurrence risk is higher with longer segments, higher dysplasia grade, hiatal hernia, older age, and tobacco use; therefore, ongoing surveillance with careful inspection and systematic biopsies is required after eradication. Surveillance intervals vary by dysplasia grade (e.g., every 3–5 years for non-dysplastic BE; closer follow-up or ablation for LGD/HGD).

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Sarel Myburgh, APRN, CNP, MS

Keywords

gastroesophageal reflux disease (GERD)

Barrett’s esophagus

esophageal adenocarcinoma (EAC)

upper endoscopy (EGD) indications

Lyon Consensus reflux diagnosis

ambulatory reflux monitoring (Bravo, pH-impedance)

proton pump inhibitors (PPI) therapy

antireflux surgery (fundoplication)

Barrett’s dysplasia surveillance intervals

endoscopic eradication therapy (EMR/ESD, RFA, cryotherapy, hybrid APC)