A client with gastroesophageal reflux disease (GERD) has a diagnosis of Barrett esophagus with minor cell changes. What principle should be integrated into the client's subsequent care?
A. Antacids may be discontinued when symptoms of heartburn subside.
B. Small amounts of blood are likely to be present in the stools and are not cause for concern.
C. The client will be monitored closely to detect malignant changes.
D. Liver enzymes must be checked regularly, as H2 receptor antagonists may cause hepatic damage.

Barrett's esophagus is a disease in which a change occurs in the cells of the lining of the lower portion of the esophagus, transforming the normal squamous epithelium from the esophagus to the columnar epithelium (typical of the stomach and intestine) called intestinal metaplasia. It coats the esophagus - the muscular tube that carries food and fluid from the mouth to the stomach - is replaced by tissue similar to the lining of the intestine. This process is called intestinal metaplasia.

People with Barrett's esophagus are at higher risk for a rare cancer called esophageal adenocarcinoma, so the patient shown in the above question will be closely monitored for malignant changes.