skip to main content

Nondysplastic Barrett esophagus — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterology/HepatologyNondysplastic Barrett esophagusABIM Board

A 58-year-old man with chronic gastroesophageal reflux disease undergoes upper endoscopy for dysphagia. Endoscopy shows a benign-appearing peptic stricture and a 3-cm segment of Barrett mucosa without nodules or other visible lesions. Biopsy of the stricture is negative for malignancy, and protocol biopsies of the Barrett segment demonstrate intestinal metaplasia without dysplasia. His dysphagia resolves after dilation. He currently takes no acid-suppressive medication. Which of the following is the most appropriate long-term management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Begin daily proton pump inhibitor therapy and schedule surveillance endoscopy

The correct answer is A. This patient has nondysplastic Barrett esophagus and a benign peptic stricture caused by chronic reflux. He should receive at least once-daily proton pump inhibitor therapy, with dosing intensified if needed for reflux control, and undergo periodic surveillance endoscopy. Current US guidance supports surveillance for nondysplastic Barrett esophagus, generally at multiyear intervals. Endoscopic eradication therapy is not routinely indicated without confirmed dysplasia or early neoplasia. Esophagectomy is reserved for selected invasive cancers and is inappropriate when biopsies show neither dysplasia nor malignancy. Sucralfate does not replace guideline-directed acid suppression, particularly after a peptic stricture. Absence of dysplasia lowers cancer risk but does not eliminate the recommendation for surveillance.

Reference: American Gastroenterological Association. Wani S, et al. AGA Clinical Practice Guideline on Surveillance of Barrett's Esophagus. Gastroenterology. 2025. https://pubmed.ncbi.nlm.nih.gov/41125322/