Counseling Barrett’s Esophagus: A PLAB 2 Mock Scenario

examiner mla
Jun 15
2 min read

Summary:

This case involves counseling a 53-year-old male patient, on the results of an endoscopic biopsy which diagnosed Barrett’s esophagus—a premalignant condition often secondary to chronic gastroesophageal reflux disease (GERD). The consultation requires explaining the condition, discussing symptom control, addressing lifestyle modifications, and planning follow-up care.

Key Points:

Gastrointestinal System / GERD and Barrett’s Esophagus

Patient presents with persistent reflux symptoms despite being on omeprazole.
Symptoms include nighttime discomfort suggestive of severe GERD.
Biopsy confirms Barrett’s esophagus, indicated by metaplasia in the lower esophagus (~5 cm segment).
No evidence of dysplasia or neoplasia was found.

Lifestyle and Risk Factors

Patient has multiple risk factors: BMI of 28, alcohol use, fast food diet, irregular meal timings, and is a delivery driver with poor lifestyle habits.
These lifestyle factors are crucial contributors to GERD and progression to Barrett’s.

Important Considerations:

Barrett’s esophagus is a pre-cancerous condition, not cancer, but has potential to progress.
Emphasize lifestyle changes: weight loss, dietary adjustments, avoiding alcohol/smoking, and consistent meal timings.
Address emotional impact and patient concerns clearly and empathetically.

Diagnostic Approach:

Confirm reflux symptoms and history.
Review biopsy results (noted metaplasia, no dysplasia).
Rule out red flag symptoms: dysphagia, weight loss, bleeding, severe pain.
Assess lifestyle and medication compliance.
Evaluate need for further tests (e.g., pH monitoring, repeat endoscopy if symptoms persist/worsen).

Management:

Medical:

Increase omeprazole dosage or consider adding H2 blockers (short-term use).
Avoid long-term H2 blockers due to tolerance.

Non-Medical:

Lifestyle modifications: diet, smoking cessation, alcohol moderation.
Provide patient information leaflets (not refer to internet directly).
Arrange follow-up in 4 weeks to reassess symptoms.

Communication Skills:

Start with clear identification and rapport building.
Use layman’s terms (e.g., "changes in the lining of your food pipe" for metaplasia).
Check for understanding repeatedly.
Avoid medical jargon and reassure without overpromising.
Empathize and address emotional reactions (“Is it cancer?”) appropriately.

Ethical Considerations:

Provide honest yet reassuring information.
Avoid stock phrases; tailor responses to patient’s concerns.
Ensure shared decision-making and document all advice.
Maintain patient dignity and address health literacy.

Additional Resources:

NICE guidelines on GERD and Barrett’s Esophagus.
GMC Good Medical Practice for communication and patient-centered care.
PLAB 2 examiner guidance on avoiding scripted responses and focusing on empathy and structure.