Clinical presentation

A 56 year old male presented with an eight week history of dyspepsia, dysphagia, and epigastric tenderness. Symptoms were controlled on a trial of proton pump inhibitor (lansoprazole) but recurred when this was discontinued. He also had a history of asthma, with numerous admissions to hospital due to bronchospasm. His medications at presentation included fluticasone, ipratropium, and salbutamol inhalers along with monteleukast and theopylline. He was a non-smoker, was not diabetic, and had no other documented illnesses. Endoscopy revealed a focal area of ulceration in the lower third of the oesophagus, in addition to more extensive confluent ulceration in the middle third. There was also duodenitis and ulceration of the first part of the duodenum. The Clo test was negative. Oesophageal biopsies (fig 1) confirmed ulceration of the oesophagus and revealed acute on chronic inflamed granulation tissue.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

 Oesophageal biopsy.

Question

What is the cause of this man’s oesophageal ulceration?

See page 133 for answer

This case is submitted by: