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.