Hard to Swallow: A Rare Cause

Excerpt

A 66-year-old woman underwent open-access upper endoscopy indicated for a two-month history of odynophagia and dysphagia for solids and liquids, described as difficulty in initiating a swallow followed by the subsequent sensation of food and liquids “holding up” in her mid-chest. Past medical history included type 2 diabetes mellitus, hypertension, and dyslipidemia; medications consisted of aspirin, rosuvastatin, losartan, hydrochlorothiazide, omeprazole, glipizide, metformin, oral potassium chloride, thyroid hormone, and insulin glargine. There had been no recent changes in medications or dosages. A focused physical examination prior to the endoscopy was unremarkable. Laboratory evaluation includes a complete blood cell count and basic metabolic panel that also revealed no abnormality. Endoscopy revealed an area of healing confluent ulceration extending over several centimeters in the hypopharynx (Fig. 1a). There was also severe, circumferential, erosive esophagitis that extended 5 cm proximally from the gastroesophageal junction (Fig. 1b). Biopsies of the distal esophagus were taken due to the possibility of a viral etiology of the severe ulceration. Following one of the esophageal biopsies, a prominent mucosal defect concerning for a superficial tear was noted for which an endoscopic hemoclip was deployed; no other complications of endoscopy occurred. In addition to standard anti-reflux measures, the patient was prescribed omeprazole.

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