GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 45-year-old man presents with a 6-year history of weekly heartburn and regurgitation despite omeprazole 20 mg daily for the past 8 months. He reports nocturnal cough and occasional dyspepsia but denies dysphagia, weight loss, or hematemesis. Vital signs are stable. Upper endoscopy reveals a salmon-colored mucosa extending 4 cm above the gastroesophageal junction. Biopsies from the distal esophagus show columnar epithelium with intestinal metaplasia containing goblet cells. No dysplasia is identified on histology. Which of the following is the most likely diagnosis?
Answer choices
- ABarrett esophagus without dysplasiaCorrect answer
- BSevere erosive esophagitis with columnar metaplasia
- CHiatal hernia with secondary intestinal metaplasia
- DLow-grade dysplasia in the setting of Barrett esophagus
- EEarly esophageal adenocarcinoma
- FChronic gastritis with proximal extension into the esophagus
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.