Presentation
Dysphagia. History of GERD.
Patient Data
Large sliding hiatus hernia.
Proximal to the hernia is a tight stricture in the distal third of the esophagus, with smooth contours.
Standing column of barium proximal to the stricture due to hold up from the stricture with delayed passage into the stomach.
Case Discussion
A real beauty of a case, which a fluoroscopic study illustrates better than any other imaging modality. The traditional studies still have their value and merits.
This shows the potential natural history of chronic esophageal reflux with a hiatus hernia.
The long term corrosive effects of acid reflux into the distal esophagus with Barrett esophagitis is a corrosive stricture.
In a small proportion, the final stage may be that the metaplasia of the mucosa of Barrett's goes a step further and becomes an adenocarcinoma of the esophagus.