A 63-year-old man, with chronic heartburn symptoms for many years, presents for reevaluation because of increased abdominal discomfort. He is taking a proton pump inhibitor for his symptoms but experiences little relief. He undergoes upper endoscopy that reveals no masses or tumors, but there is esophagitis. Biopsy of the lower esophagus reveals columnar cells. Which of the following statements is correct?
(A) it is a major risk factor for squamous
cell cancer of the esophagus
(B) it can be found in up to 20% of patients
undergoing esophagoscopy for
esophagitis
© the histologic changes include
development of keratinized squamous
cells
(D) medical control of reflux will decrease
the likelihood of malignant changes
(E) only 10% of patients with Barrett’s
esophagus may develop malignancy
solution
(B) Barrett’s esophagus, characterized by a columnar cell-lined esophageal mucosa, is a major risk factor for adenocarcinoma of the esophagus. Although acid reflux may be a predisposing factor, there is no evidence that either medical or surgical antireflux measures alter the outcome. It is found in about 20% of patients
undergoing endoscopy for esophagitis, and up to 50% may develop a malignancy