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JAMA Clinical Challenge
January 31, 2020

Dysphagia in a 34-Year-Old Woman

Author Affiliations
  • 1Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
  • 2Durham Veterans Affairs Medical Center, Durham, North Carolina
JAMA. 2020;323(7):660-661. doi:10.1001/jama.2019.19121

A 34-year-old woman presented with 2 years of progressively worsening intermittent dysphagia, primarily to solids, especially meats, localized retrosternally. She reported no heartburn, nausea, vomiting, abdominal pain, weight loss, or changes in bowel habits. She reported no medications or comorbidities. Physical examination was unremarkable. Results of a recent complete blood cell count were normal. Despite taking ranitidine (150 mg twice daily), she continued to have bothersome daily dysphagia, prompting her primary care clinician to order esophagogastroduodenoscopy (EGD). The EGD showed vertical furrows and circumferential rings in the esophagus (Figure 1A), while the stomach and duodenum appeared normal. Four biopsies each were taken from the proximal and distal esophagus (Figure 1B).

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