PPIs for intestinal metaplasia of the gastroesophageal junction

Would you prescribe proton pump inhibitors (PPIs) for patients with intestinal metaplasia of the gastroesophageal junction when the biopsy was taken from a Z line with <1 cm of variability?

Paul Moayyedi, MB ChB, PhD: Only for symptoms. If they have bad reflux symptoms, they can still have a normal gastroesophageal junction with reflux, so I would still prescribe a PPI.

If, on the other hand, they feel fine and you were doing the endoscopy for whatever reason, then I would not prescribe a PPI. As I said [see: Diagnostic criteria for Barrett esophagus], I feel it is a normal variant. I would just leave them alone.

See also

Surgical treatment in GERD Which patients with gastroesophageal reflux disease should be referred for surgical treatment?
Assessing the effectiveness of oral pancreatic enzyme supplementation How should we assess the effectiveness of oral supplementation of pancreatic enzymes?
Diagnostic criteria for Barrett esophagus What is essential for the diagnosis of Barrett esophagus?
Preventing adverse effects of long-term PPI therapy How to prevent the potential adverse effects of long-term treatment with proton pump inhibitors (PPIs)?
How to manage incidental pancreatic cysts in an evidence-based era A lecture by Dr Paul Moayyedi, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Approach to a patient with decompensated liver cirrhosis A lecture by Dr Pere Ginès, from University of Barcelona, Spain, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Current management of dyspepsia A lecture by Dr Paul Moayyedi, from McMaster University, Canada, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Management of GERD and Barrett esophagus A lecture by Dr Janusz Jankowski, from the Royal College of Surgeons in Ireland, Ireland, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2018.
PPIs in patients receiving NSAIDs Should proton pump inhibitors (PPIs) be prescribed in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs)?
PPIs in patients receiving oral glucocorticoids Should proton pump inhibitors (PPIs) be prescribed in patients treated with oral glucocorticoids?

PPIs for intestinal metaplasia of the gastroesophageal junction

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