MKSAP: 54-year-old man with dysphagia

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. There is no family history of colorectal cancer.

Physical examination findings are unremarkable.

Upper endoscopy reveals a 3-cm hiatal hernia, an esophageal (Schatzki) ring, and approximately six polyps smaller than 4 mm in the fundus and upper body of the stomach. The duodenum is normal. The esophageal ring is dilated, and biopsy of random gastric polyps confirms fundic gland polyps without dysplasia.

Which of the following is the most appropriate next step in management?

A. Perform APC gene testing
B. Perform excision of all fundic gland polyps
C. Repeat colonoscopy
D. Stop PPI therapy
E. Reassurance

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