Esophageal Ulcerations - Case

69-year-old female patient was referred for gastroscopy examination in the beginning of April due to acute dysphagia (for 7 days), pain/burning sensation along the sternum, pain in the epigastrium. In the ED myocardial infarction was excluded (ECG without depolarization abnormalities, negative troponin). The patient reports paroxysmal atrial fibrillation and hypothyroidism. She is treated with Pradaxa, Polfenon, Concor, Euthyrox and Lanzul. The gastroscopy reveals regular Z-line located on the upper border of gastric folds. In the lower esophagus longitudinal, linear (length 1,5-2 cm) mucosal bulge/scar covered with fibrin is present (1). 35 cm from incisors there is a flat, diffused erosion surrounded by slightly elevated mucosa. 4 biopsy specimens were collected (2), the lesion was soft on biopsy. In the upper esophagus, right under the upper esophageal sphincter another extensive erosion covered with fibrin, surrounded by elevated mucosa was noted. 3 biopsy specimens were taken (3). Histopathology revealed 1. erosio oesophagi. 2 and 3.ulceratio profunda oesophagii cum proliferatione reactivae et dysplasia reactivae epithelii. Follow-up appointment in the middle of April - significant dysphagia reduction (without any treatment from prior gastroscopy). The patient was put on Esoxx, Dexilant and Pramolan (because of stress intolerance). She was scheduled for subsequent gastroscopy examinations with biopsies in June and September.