A 50-year-old obese man (BMI =32 kg/m2) comes to the physician complaining of indigestion after meals, bloating, and heartburn. Vital signs are normal. A CT scan of the abdomen reveals a hiatal hernia of the esophagus. Endoscopic biopsy shows thickening of the basal layer of the squamous epithelium, upward extension of the papillae of the lamina propria, and an increased number of neutrophils and lymphocytes. Which of the following is the most likely diagnosis?
Esophagitis may be caused by infections, reflux of gastric juice, or exogenous irritants. Of these, the most common type is reflux esophagitis, which is often found in conjunction with a sliding hiatal hernia but may also arise through an incompetent lower esophageal sphincter without any demonstrable anatomical lesion. Chronic exposure to stomach juice causes reactive thickening of the squamous epithelium (leukoplakia) and the underlying stroma. Areas affected by gastric reflux are susceptible to mucosal erosions and ulcers which appear as linear vertical streaks. Neutrophils and lymphocytes accumulate in the mucosa. The other choices are not typical complications of hiatal hernia.Diagnosis: Reflux esophagitis, hiatal hernia
Esophageal varices
Mallory-Weiss syndrome
Reflux esophagitis
Schatzki mucosal ring
G.I.T.