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In yesterday’s "Weekly Medical Questions" column, we pushed the latest issue of NEJM Knowledge+ Question of the Week.
Which test should be perfected for a 60-year-old man who is seeing a doctor with heartburn? Today, we announce the answer.
Do you see the answer? Of course, answering right is not the goal, but mastering the essentials and expanding knowledge is the kingly way.
Answer: Key points for esophageal gastroduodenal endoscopy: The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors.
Barrett's esophagus and esophageal adenocarcinoma should be evaluated.
Knowledge Expansion This male patient is 60 years old, has long-term gastroesophageal reflux disease (GERD), and has a history of smoking.
He should undergo esophageal gastroduodenoscopy (EGD) to assess for Barrett's esophagus and esophageal adenocarcinoma.
The current guidelines recommend that for men with chronic (>5 years) and/or frequent (at least once a week) symptoms of gastroesophageal reflux disease (heartburn or acid reflux), if two or more of the following esophagus are combined Risk factors for adenocarcinoma should be considered for esophageal gastroduodenoscopy: Caucasians aged> 50 years with central obesity (waist circumference> 102 cm or waist-to-hip ratio> 0.
9).
Current smoking or smoking history first-degree relatives diagnosed with BE or family history of esophageal adenocarcinoma.
If EGD examination does not find reflux esophagitis, Barrett’s esophagus or esophageal adenocarcinoma, and the patient’s symptoms do not improve after the dose of acid-suppressing drugs is increased, then Esophageal pH testing may help determine whether the patient’s symptoms are due to persistent acid reflux.
Barium swallow imaging may be helpful in evaluating dysphagia and dysphagia.
It can indicate esophageal tumors, diverticulum or stenosis, or some gastrointestinal motility disorders, but it is of no value in the diagnosis of Barrett's esophagus.
For acute abdomen that may be caused by intestinal perforation or intestinal obstruction, consider abdominal X-ray examination.
For patients without abdominal tenderness, the value of abdominal plain radiographs is limited.
CT of the chest, abdomen, and pelvis may help determine the cause of acute chest and abdominal pain.
In addition, the staging of malignant tumors often requires completion of these three checks.
The patient currently has no clear indication of CT examination.
【Weekly Medical Questions】will continue to be updated.
What do you want to see or learn? Please tell us through the comments and look forward to your precious comments and suggestions.
References 1.
Spechler SJ and Souza RF.
Barrett's esophagus.
N Engl J Med 2014 Aug 28; 371:836.
2.
Shaheen NJ et al.
ACG clinical guideline: diagnosis and management of Barrett's esophagus.
Am J Gastroenterol 2016 Jan; 111:30 Copyright information.
This article was translated, written or commissioned by "NEJM Frontiers in Medicine" jointly created by Jiahui Medical Research and Education Group (JMRE) and "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors and should be evaluated for Barrett's esophagus and esophageal adenocarcinoma.
Which test should be perfected for a 60-year-old man who is seeing a doctor with heartburn? Today, we announce the answer.
Do you see the answer? Of course, answering right is not the goal, but mastering the essentials and expanding knowledge is the kingly way.
Answer: Key points for esophageal gastroduodenal endoscopy: The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors.
Barrett's esophagus and esophageal adenocarcinoma should be evaluated.
Knowledge Expansion This male patient is 60 years old, has long-term gastroesophageal reflux disease (GERD), and has a history of smoking.
He should undergo esophageal gastroduodenoscopy (EGD) to assess for Barrett's esophagus and esophageal adenocarcinoma.
The current guidelines recommend that for men with chronic (>5 years) and/or frequent (at least once a week) symptoms of gastroesophageal reflux disease (heartburn or acid reflux), if two or more of the following esophagus are combined Risk factors for adenocarcinoma should be considered for esophageal gastroduodenoscopy: Caucasians aged> 50 years with central obesity (waist circumference> 102 cm or waist-to-hip ratio> 0.
9).
Current smoking or smoking history first-degree relatives diagnosed with BE or family history of esophageal adenocarcinoma.
If EGD examination does not find reflux esophagitis, Barrett’s esophagus or esophageal adenocarcinoma, and the patient’s symptoms do not improve after the dose of acid-suppressing drugs is increased, then Esophageal pH testing may help determine whether the patient’s symptoms are due to persistent acid reflux.
Barium swallow imaging may be helpful in evaluating dysphagia and dysphagia.
It can indicate esophageal tumors, diverticulum or stenosis, or some gastrointestinal motility disorders, but it is of no value in the diagnosis of Barrett's esophagus.
For acute abdomen that may be caused by intestinal perforation or intestinal obstruction, consider abdominal X-ray examination.
For patients without abdominal tenderness, the value of abdominal plain radiographs is limited.
CT of the chest, abdomen, and pelvis may help determine the cause of acute chest and abdominal pain.
In addition, the staging of malignant tumors often requires completion of these three checks.
The patient currently has no clear indication of CT examination.
【Weekly Medical Questions】will continue to be updated.
What do you want to see or learn? Please tell us through the comments and look forward to your precious comments and suggestions.
References 1.
Spechler SJ and Souza RF.
Barrett's esophagus.
N Engl J Med 2014 Aug 28; 371:836.
2.
Shaheen NJ et al.
ACG clinical guideline: diagnosis and management of Barrett's esophagus.
Am J Gastroenterol 2016 Jan; 111:30 Copyright information.
This article was translated, written or commissioned by "NEJM Frontiers in Medicine" jointly created by Jiahui Medical Research and Education Group (JMRE) and "New England Journal of Medicine" (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors and should be evaluated for Barrett's esophagus and esophageal adenocarcinoma.
