Clinical presentation

A 51-year-old man presented to our gastroenterology clinic complaining of bloating and belching. His medical history was significant for diabetes mellitus and thyroidectomy for papillary thyroid cancer. He reported occasional heartburn but denied any abdominal pain, change in bowel habits, weight loss or family history of malignancy. One of his children had autism. Physical examination was noted for asymptomatic skin-coloured lesions over the feet (figure 1A) but was otherwise negative. Upper gastrointestinal endoscopy showed numerous whitish plaques in the oesophagus (figure 1B), along with multiple small polyps in the stomach (figure 1C) and …