Interactive Case Study Companion

iii - Scenario  
Normal Reference Range Table

The patient is a 51-year-old white male who presented 10 years prior to surgery with a history of heartburn, regurgitation, and epigastric pain. Endoscopy was performed, and a large erythematous area involving the distal esophagus was noted. Biopsy specimens were taken and showed features of reflux esophagitis. The patient was treated with antireflux drugs and given a follow-up appointment in one year. The patient returned three years later, complaining of dysphagia, heartburn, and epigastric pain. Endoscopy was again performed, and revealed that the normal white squamous mucosa lining the distal esophagus was replaced by pink columnar mucosa. Biopsy specimens were taken, which subsequently showed metaplastic columnar epithelium containing intestinal goblet cells. Because of the diagnosis of Barrett esophagus, the patient was enrolled in a surveillance program, and yearly endoscopic procedures were recommended. Six years prior to surgery, endoscopy showed extensive Barrett esophagus, and biopsy specimens showed features of dysplasia. He failed to return for subsequent surveillance endoscopy. One month prior to surgery, the patient was admitted with a one-month history of dysphagia. An upper GI series (radiographs) revealed distal narrowing of the esophagus. Endoscopic examination of the esophagus revealed an ulcerating mass in the distal esophagus. A biopsy was performed. The patient was taken to surgery, where an esophagogastrectomy was performed.



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