A 44-Year-Old Man with a Long-Standing History of Heartburn Comes

question 65

Multiple Choice

A 44-year-old man with a long-standing history of heartburn comes to the office due to worsening substernal burning, particularly at night.  The discomfort has been less responsive than usual to over-the-counter antacids.  The patient also now has significant substernal pain after swallowing food.  However, swallowing does not result in coughing, choking, or a sensation of food getting stuck.  He has no other chronic medical conditions.  Recent HIV testing was negative.  The patient takes no other medications.  He drinks 2 or 3 beers each evening and smokes a pack of cigarettes daily.  BMI is 34 kg/m².  Vital signs are within normal limits.  Physical examination reveals no abnormalities.  The recent worsening of this patient's symptoms is most likely related to which of the following?

• A)Columnar metaplasia
• B)Herpes simplex infection
• C)Malignancy
• D)Stricture
• E)Ulceration

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