A patient with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett's esophagus with minor cell changes. Which of the following principles should be integrated into the patient's subsequent care?
A) The patient will require an upper endoscopy every 6 months to detect malignant changes.
B) Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.
C) Small amounts of blood are likely to be present in the stools and are not cause for concern.
D) Antacids may be discontinued when symptoms of heartburn subside.
Ans: A
Feedback:
In the patient with Barrett's esophagus, the cells lining the lower esophagus have undergone change and are no longer squamous cells. The altered cells are considered precancerous and are a precursor to esophageal cancer. In order to facilitate early detection of malignant cells, an upper endoscopy is recommended every 6 months. H2 receptor antagonists are commonly prescribed for patients with GERD; however, monitoring of liver enzymes is not routine. Stools that contain evidence of frank bleeding or that are tarry are not expected and should be reported immediately. When antacids are prescribed for patients with GERD, they should be taken as ordered whether or not the patient is symptomatic.
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