A 59-year-old man presents to the gastroenterology clinic for evaluation of chronic reflux symptoms. He reports heartburn occurring several times per week for more than 15 years despite intermittent use of over-the-counter antacids. His medical history is significant for obesity and hypertension. He has a 25-pack-year smoking history. Vital signs are normal. Physical examination is unremarkable. Upper endoscopy reveals salmon-colored mucosa extending proximally from the gastroesophageal junction. Biopsy demonstrates intestinal metaplasia with goblet cells.
Which of the following complications is this patient at greatest risk of developing?
The correct answer is:
A) Esophageal adenocarcinoma
This patient has Barrett esophagus, a complication of chronic gastroesophageal reflux disease characterized by replacement of normal squamous epithelium with intestinal-type columnar epithelium containing goblet cells. Barrett esophagus is the primary precursor lesion for esophageal adenocarcinoma. Risk factors include longstanding gastroesophageal reflux disease (GERD), obesity, male sex, and smoking.
Answer choice B: Esophageal perforation, is incorrect.
Perforation is typically caused by instrumentation, trauma, or forceful vomiting. Barrett esophagus increases malignancy risk rather than rupture risk.
Answer choice C: Esophageal squamous cell carcinoma, is incorrect.
Both adenocarcinoma and squamous cell carcinoma affect the esophagus, making this a plausible distractor. However, Barrett esophagus specifically predisposes to adenocarcinoma. Squamous cell carcinoma is more strongly associated with tobacco use, alcohol use, achalasia, and caustic injury.
Answer choice D: Gastric adenocarcinoma, is incorrect.
Although intestinal metaplasia can occur in the stomach, Barrett esophagus involves the distal esophagus. The major malignant complication is esophageal adenocarcinoma.
Answer choice E: Mallory-Weiss tear, is incorrect.
Mallory-Weiss tears result from forceful retching and cause upper gastrointestinal bleeding. Barrett esophagus does not increase the risk of these mucosal lacerations.
Key Learning Point
Barrett esophagus is characterized by intestinal metaplasia of the distal esophagus and is the primary precursor lesion for esophageal adenocarcinoma.
