Core IM | Internal Medicine Podcast #33 Barrett's Esophagus: 5 Pearls
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Jan 30, 2019 Dr. Vishal Shah, a hospitalist and incoming preventive health fellow at Mayo, and Dr. Milna Rufin, a primary care resident and incoming chief, break down Barrett's esophagus. They define the disease and cancer risk. They cover who to screen and how, biopsy interpretation and counseling, PPI use and ablation strategies, and practical surveillance and follow-up pearls.
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Hosts' Personal Heartburn Confessions
- Dr. Marty Fried confessed to loving spicy condiments and worried about Barrett's from med-school hypochondria.
- Milna Rufin admitted to constant heartburn and fearing she might have Barrett's.
Definition And Cancer Risk
- Barrett's esophagus is metaplasia where esophageal squamous cells become columnar cells from chronic injury.
- High-grade dysplasia carries about a 7% annual risk of progressing to adenocarcinoma.
Screening Must Be Targeted
- Screening targets must balance cost and yield because EGD is expensive and cancer is relatively rare.
- The 2016 ACG guidance favors screening high-risk groups to improve cost-effectiveness.