Abstract

The clinical case of a 25-year-old male patient is presented, with a history of abundant intake of spicy 3-4 times a week, intake of alcoholic beverages 8 ounces on average per week he comes to a medical consultation for presenting heartburn and regurgitation of 3 months of evolution he had been treated by a family doctor with omeprazole, metoclopramide and trimebutine 200mg, without improvement, in the last two weeks low dysphagia was added to solid food, reason for consulting a specialist doctor. He is instructed to perform panendoscopy with biopsy, which reports grade “C” esophagitis, exophytic lesion with smooth edges, pale pink, well delimited around 1.5cm long linear erosion, soft consistency (Figure 1) and smooth after taking biopsies, located in the lower third of the esophagus, as well as follicular gastropathy located in the antrum, biopsies were also taken from this area in separate vials; the histopathological report of the biopsies of the esophageal lesion in the microscopic description mentions papillary projections with fibrovascular axes covered by nonkeratinized stratified flat epithelium with areas of erosion and recent hemorrhage, (Figure 2) concluding flat squamous papilloma, chronic esophagitis due to grade reflux II, without evidence of dysplastic changes and/or Barrett. Gastric biopsies reported chronic gastritis of the follicular variety with moderate activity associated with infection by Helicobacter pylori bacilli in moderate quantity.