A Case of Esophageal Pseudomembranes

Abstract

290 Question: A 36-year-old woman presented for evaluation of chronic retrosternal burning. She continued to have daily symptoms despite using omeprazole twice daily. She rarely had liquid regurgitation. Otherwise, she denied dysphagia, odynophagia, and weight loss. Her medical history was notable for migraine headaches and constipationpredominant irritable bowel syndrome. Aside from omeprazole, the only other medication used was an oral contraceptive. Because of the persistence of her symptoms despite high-dose proton pump inhibitor treatment, she underwent testing. Esophageal manometry demonstrated frequent failed peristalsis, but normal basal lower esophageal sphincter pressure and normal relaxation. A subsequent barium esophagram demonstrated normal esophageal peristalsis. An esophagogastroduodenoscopy revealed large white membranes adjacent to normal appearing mucosa in both the mid and distal esophagus (Figure A). Esophageal biopsies were obtained (Figure B). What is the most likely diagnosis? Look on page 489 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.