A 44-Year-Old Man with a Long-Standing History of Heartburn Comes

A 44-year-old man with a long-standing history of heartburn comes to the office due to worsening substernal burning, particularly at night.  The discomfort has been less responsive than usual to over-the-counter antacids.  The patient also now has significant substernal pain after swallowing food.  However, swallowing does not result in coughing, choking, or a sensation of food getting stuck.  He has no other chronic medical conditions.  Recent HIV testing was negative.  The patient takes no other medications.  He drinks 2 or 3 beers each evening and smokes a pack of cigarettes daily.  BMI is 34 kg/m².  Vital signs are within normal limits.  Physical examination reveals no abnormalities.  The recent worsening of this patient's symptoms is most likely related to which of the following?

A) Columnar metaplasia
B) Herpes simplex infection
C) Malignancy
D) Stricture
E) Ulceration

Correct Answer:

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