A 53-year-old man arrives at the emergency room after experiencing severe heartburn and difficulty swallowing for several weeks. He has had mild to moderate heartburn for several years and has tried weight loss, elevating the head of his bed while sleeping, and proton pump inhibitor therapy for several months. Hypertension and hypothyroidism are two other medical issues. The temperature is 36.7 C (98.1 F), the blood pressure is 130/80 mm Hg, the pulse rate is 78 bpm, and the respirations rate is 16/ min. The BMI is 25 kg/m2². The physical exam is unremarkable. An upper gastrointestinal endoscopy is performed, and an esophageal biopsy reveals columnar epithelium with goblet cells interspersed. A similar adaptive response can be seen in which of the following scenarios?

Question

Quizplus · Accepted Answer

Eductional Objective: Metaplasia is the replacement of one differentiated cell type by another as a result of an adverse environmental stimulus. It is frequently observed in the bronchi of chronic cigarette smokers (replacement of ciliated columnar epithelium with stratified squamous cells) and the distal esophagus of patients with chronic gastroesophageal reflux (substitution of stratified squamous epithelium with intestinal columnar cells). Metaplasia can progress to dysplasia and malignant transformation.

A 53-Year-Old Man Arrives at the Emergency Room After Experiencing