Nurten Kucukmetin

A Woman With Longstanding Dysphagia

f i Question: A 70-year-old woman was referred to the endoscopy unit for dyspeptic symptoms. She had a prior history of mild dysphagia for 40 years without associated weight loss or anorexia. Her physical examination and laboratory tests were unremarkable. An upper gastrointestinal endoscopy showed circumferential narrowing of 4 cm in length of the distal esophagus with intact mucosa extending to the gastroesophageal junction (Figure A). Esophageal dilatation above the lesion was not noted, and the gastric cardia seemed normal. Barium swallow x-ray series showed smooth narrowing of the distal esophagus (Figure B). Computerized tomography scan of the chest and upper abdomen demonstrated circumferential thickening of the esophageal wall ( 1 cm) in the lower esophagus (Figure C). Endoscopic biopsy of the distal esophagus extending to the muscularis mucosa layer did not reveal any pathologic findings. What is your diagnosis? Look on page 1362 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) or more information on submitting your favorite mage to Clinical Challenges and Images in GI. NURTEN T. KUCUKMETIN International Hospital Gastroenterology Department BAHATTIN CICEK Acibadem Maslak Hospital Gastroenterology Department NURDAN TOZUN Acibadem University Gastroenterology Clinic İstanbul, Turkey