MEDizzy - A 50-year-old man with a history of alcohol and tobacco

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Gastroenterology 2

A 50-year-old man with a history of alcohol and tobacco abuse has complained of difficulty swallowing solid food for the past 2 months. More recently, swallowing fluids has also become a problem. He has noted black, tarry stools on occasion. The patient has lost 10 lb. Which of the following statements is correct?

ExplanationThe most likely diagnosis in this patient is esophageal carcinoma. Dysphagia is progressive, first for solids and then liquids. There is blood in the stool and a history of weight loss. Alcohol use and cigarette smoking are risk factors. Prognosis is not good in this patient. Difficulty swallowing suggests significant esophageal narrowing, and usually this means that the disease is incurable. A barium contrast study should demonstrate an esophageal carcinoma with marked narrowing and an irregular, ragged mucosal pattern. Formerly, squamous cell carcinoma accounted for 90% of esophageal cancer, but its incidence is decreasing. Now more than 50% are adenocarcinomas, most often associated with Barrett esophagus. CT scan of the abdomen and pelvis is not helpful in demonstrating esophageal pathology. Peptic ulcer disease does not cause dysphagia. Achalasia would not cause guaiac-positive stools or progressive symptoms. Herpes simplex virus can cause an acute esophagitis in immunocompromised patients. It is characterized by odynophagia, not progressive dysphagia.