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Case of the Month: Older Adult With Heartburn

By Numbereye Numbere, MBBS (PGY-3), Brandon Sprung, MD, and Rossana Kazemimood, MD

Clinical History

An older woman presented to the clinic with complaints of dysphagia and burning retrosternal pain.

Past Medical History

The patient has a history of multiple medical conditions, including chronic pain, hypertension, and hypothyroidism, for which she takes several medications. An esophagogastroduodenoscopy was performed.

Recent History

Findings on endoscopy include mucosal plaques and rings in the mid-esophagus (Fig. 1-3). On microscopy, the esophageal epithelium has a dual-tone appearance with a superficial layer of necrotic deeply eosinophilic squamous cells overlying a deep layer of viable epithelium (Fig. 4-6), separated on occasion by a band of necrotic, spongiotic squamous cells and neutrophils (Fig. 6).

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