GERD
A 45-year-old man presents with chronic heartburn and regurgitation, worse after meals and when lying down. Endoscopy is normal, and biopsy shows squamous epithelium without changes. Which of the following is the most appropriate next step?
Start proton pump inhibitor therapy
A 58-year-old man with chronic heartburn undergoes endoscopy showing salmon-colored mucosa. Biopsy demonstrates intestinal-type columnar epithelium with goblet cells. What is the diagnosis?
Barrett’s esophagus
Which part of the esophagus is most commonly affected by adenocarcinoma?
Distal esophagus
A 35-year-old woman presents with heartburn. Which of the following conditions is a major risk factor for GERD?
A. Hypothyroidism
B. Obstructive sleep apnea
C. Hiatal hernia
D. Primary biliary cholangitis
E. Crohn’s disease
C. Hiatal hernia
Barrett’s esophagus is an example of which cellular process?
Metaplasia
A 70-year-old man presents with progressive dysphagia first for solids, then liquids. He has a history of GERD and Barrett’s. Which diagnosis is most likely?
Adenocarcinoma
Which histologic change is most likely observed in the distal esophagus of a patient with uncomplicated long-standing GERD?
metaplastic columnar epithelium replacing the normal squamous lining, with the hallmark being intestinal metaplasia (goblet cells).
A patient with Barrett’s esophagus is at increased risk of which malignancy?
Esophageal adenocarcinoma
Which of the following risk factors is more strongly associated with adenocarcinoma compared to squamous cell carcinoma?
A. Alcohol consumption
B. Tobacco use
C. Barrett’s esophagus
D. Nitrosamine exposure
E. Plummer-Vinson syndrome
C. Barrett’s esophagus
A 37-year-old woman has a 3-year history of heartburn. Symptoms are worse after large meals and when lying flat. She has tried antacids with little relief. What would be the most specific diagnostic test for confirming GERD?
C. 24-hour esophageal pH monitoring
A 64-year-old man with Barrett’s undergoes endoscopy showing low-grade dysplasia. Which management is most appropriate?
Endoscopic ablation or resection
A 72-year-old man with a long history of GERD presents with progressive dysphagia and unintentional weight loss. Endoscopy reveals a mass in the distal esophagus. Biopsy confirms adenocarcinoma. Which of the following is the earliest symptom most patients with esophageal adenocarcinoma report?
A. Dysphagia to solids
B. Dysphagia to liquids
C. Hoarseness
D. Hematemesis
E. Chest pain at rest
A. Dysphagia to solids
Which of the following mechanisms most likely underlies GERD in obese patients?
Decreased LES tone
A 59-year-old man with a history of long-standing GERD undergoes endoscopy, which shows areas of erythematous mucosa in the distal esophagus. Biopsy demonstrates intestinal-type metaplasia. Which molecular pathway is most implicated in progression from Barrett’s esophagus to adenocarcinoma?
B. TP53 mutations and p16 inactivation
Which of the following best distinguishes esophageal adenocarcinoma from esophageal squamous cell carcinoma in terms of geographic prevalence?
A. Adenocarcinoma is most common worldwide
B. Squamous cell carcinoma predominates in North America
C. Adenocarcinoma is most common in Western countries
D. Adenocarcinoma >80% of esophageal cancers worldwide
E. Squamous cell carcinoma is rare in Asia
C. Adenocarcinoma is most common in Western countries