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Clinical pathological cases in gastroenterology: Esophagus

Andres Gelrud, MD, MMSc
Section Editor
J Thomas Lamont, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


The following cases are meant to illustrate clinical, pathological, and endoscopic findings in patients with a variety of esophageal conditions. Detailed discussions on the specific disorders are presented on corresponding topic reviews.


A 62 year old woman awakened with severe odynophagia and dysphagia. Her only medical problem is osteoporosis treated with alendronate (Fosamax®) over the past eight months. Her weight has been stable and she denies having fevers, nausea, vomiting, or abdominal pain. She denies a prior history of dysphagia. An upper endoscopy was performed (picture 1A-B). (See "Medication-induced esophagitis".)


A 36 year old obese male underwent an upper endoscopy with biopsies for the evaluation of worsening heartburn over the past nine months. He has no other medical problems and denies any nausea, vomiting, abdominal pain, odynophagia, dysphagia, or weight loss. Endoscopy revealed multiple elevated gray-white nodules in the upper and middle third of the esophagus (picture 2 and picture 3) A long segment of salmon colored mucosa was seen in the distal esophagus (picture 4).


An 83 year old man presented to his primary care physician with worsening dysphagia, initially to solids and now to liquids. His medical problems include hypertension treated with atenolol, chronic obstructive pulmonary disease treated with inhaled steroids and bronchodilators, and long history of heartburn self-treated with over the counter antacids. His weight has been trending down and he has lost 16 lbs over the past two months. He denies fevers, nausea, vomiting, abdominal pain, or odynophagia. An upper endoscopy (picture 5A-B) with biopsies (picture 6) was performed. An endoscopic ultrasound showed the following (image 1). (See "Diagnosis and staging of esophageal cancer".)

Further evaluation revealed metastatic disease. The patient refused chemotherapy or radiation therapy. Endoscopic palliation therapy was performed (picture 7 and image 2). (See "Endoscopic palliation of esophageal cancer".)

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Literature review current through: Nov 2017. | This topic last updated: Feb 23, 2017.
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