GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 45-year-old man presents with progressive dysphagia to solids over the past 3 months. He has had chronic heartburn and regurgitation for 12 years, managed with omeprazole 20 mg daily for the past 8 years. He denies odynophagia, fever, or recent antibiotic use. Vital signs are stable. Upper endoscopy shows a salmon-colored mucosa in the distal esophagus extending 6 cm above the gastroesophageal junction, with areas of irregular nodularity. Biopsies from the distal esophagus demonstrate columnar epithelium with intestinal metaplasia and high-grade dysplasia. Which of the following is the most likely diagnosis?
Answer choices
- AEsophageal adenocarcinoma
- BBarrett esophagus with high-grade dysplasiaCorrect answer
- CInfectious esophagitis secondary to Candida albicans
- DMedication-induced esophagitis from omeprazole
- EAchalasia with secondary candidal infection
- FGastric intestinal metaplasia with proximal migration
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