A 52-year-old male with chronic gastroesophageal reflux disease undergoes screening endoscopy. Biopsy of the lower esophagus demonstrates replacement of stratified squamous epithelium by columnar epithelium with goblet cells (intestinal metaplasia). What is this condition?

Answer and explanation

Correct answer: D. Barrett's esophagus

  1. Step 1: Barrett's esophagus is a premalignant condition resulting from chronic acid-peptic injury.
  2. Step 2: Normal stratified squamous epithelium of the distal esophagus undergoes specialized metaplasia into intestinal-type columnar epithelium with mucin-containing goblet cells.
  3. Step 3: It carries an increased risk of progression to esophageal adenocarcinoma.
Answer
Barrett's esophagus.
Why not the others: 'Squamous cell carcinoma in situ' features malignant dysplastic squamous cells without columnar metaplasia; 'Mallory-Weiss tear' is a mechanical longitudinal mucosal tear at the gastroesophageal junction caused by violent retching; 'Zenker's diverticulum' is a pharyngeal pouch arising above the upper esophageal sphincter.

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