A 52-year-old man with heartburn and weight loss

A previously fit and well 52-year-old man presented to the hospital with a 3-month history of refractory heartburn and progressive weight loss (5 kg). After an initial response to empiric treatment with 20 mg omeprazole daily, heartburn relapsed and became refractory to proton pump inhibitor. His past medical history and physical examination were unremarkable. Upper endoscopy showed a thick white membrane in the distal part of the oesophagus, crossing the gastro-oesophageal junction (figure 1A); the mucosa surrounding the distal margin was slightly depressed but not reddened. An initial diagnosis of candidosis was suggested and the patient unsuccessfully treated with nystatin. The biopsies showed no abnormalities, in particular no signs of inflammation. All laboratory tests, including serological tests for cytomegalovirus, herpes and HIV infection, were negative. Upper endoscopy and extensive tissue sampling were repeated. Question What is the diagnosis? See page 1288 for answer See page 1267 for...
Source: Gut - Category: Gastroenterology Authors: Tags: GUT Snapshot Editor ' s quiz: GI snapshot Source Type: research