A 49-Year-Old Man Comes to the Office for Evaluation of a Dry

A 49-year-old man comes to the office for evaluation of a dry cough that occurs mainly at night.  His symptoms have been present on and off for several years, but he has not been previously evaluated.  The patient also reports a frequent sore throat and occasional epigastric discomfort.  He has tried a variety of antihistamines and over-the-counter cough medications without relief.  Past medical history is notable for obesity and diet-controlled type 2 diabetes mellitus.  He does not smoke or drink alcohol.  Cardiopulmonary and abdominal examinations are unremarkable.  Chest x-ray reveals no abnormalities, and pulmonary function testing is normal.  The patient undergoes upper gastrointestinal endoscopy with mucosal biopsies.  Microscopic findings on lower esophageal biopsy are shown in the image below. This patient is at highest risk of which of the following complications?

A) Achalasia
B) Adenocarcinoma
C) Crohn disease
D) Squamous cell carcinoma
E) Variceal bleeding

Correct Answer:

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