A 62-year-old man was referred with long-standing heartburn. His medical and surgical history was non-contributory. The first upper GI endoscopy (Fig.
a) revealed white membranes involving the entire esophagus, and longitudinal lacerations were seen on insufflation. Biopsies from the proximal and distal esophagus were taken and diagnosed with unspecific inflammatory changes with no diagnostic criteria of eosinophilic esophagitis or presence of specific pathogens. Clinical manifestations were considered secondary to reflux esophagitis, and the patient was started on maximal dose proton pump inhibitor (PPI) therapy for 12 weeks. During this time period, the patient’s condition gradually declined and he developed dysphagia and food impaction. For this reason, a new upper endoscopy was performed and revealed a severe stenosis in the upper third of the esophagus with persistence of linear lacerations all over the esophageal length (Fig.
b). A new biopsy was taken and...