Differential Diagnosis for Squamocolumnar Junction Mucosa with Acute and Chronic Inflammation
- Single Most Likely Diagnosis
- Inflammatory bowel disease (IBD), specifically ulcerative colitis or Crohn's disease: The presence of both acute and chronic inflammation at the squamocolumnar junction, which is the transition zone between the squamous epithelium of the esophagus and the columnar epithelium of the stomach, suggests a condition that causes ongoing inflammation. IBD is a common cause of such findings, particularly if the inflammation extends into the stomach (gastric involvement in Crohn's disease) or starts in the rectum and extends proximally in a continuous manner (ulcerative colitis).
- Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Chronic reflux of stomach acid into the esophagus can cause inflammation at the squamocolumnar junction, leading to a condition known as Barrett's esophagus, which is characterized by metaplastic change of the esophageal lining to a columnar type. While GERD itself might not directly cause acute inflammation, the chronic nature of the disease and potential for intermittent acute exacerbations make it a consideration.
- Infectious esophagitis: Certain infections, such as those caused by Candida, herpes simplex virus, or cytomegalovirus, can lead to both acute and chronic inflammation, especially in immunocompromised patients.
- Do Not Miss Diagnoses
- Esophageal cancer: Although less likely, it is crucial not to miss esophageal cancer, particularly adenocarcinoma, which often arises from the background of chronic inflammation and metaplastic changes in the esophagus, such as those seen in Barrett's esophagus. Early detection significantly improves prognosis.
- Eosinophilic esophagitis: This condition, characterized by an eosinophil-predominant inflammation, often presents with dysphagia and food impaction. It can have both acute and chronic components and is important to diagnose due to its implications for treatment and potential for complications like esophageal stricture.
- Rare Diagnoses
- Lymphocytic esophagitis: A rare condition characterized by lymphocytic infiltration of the esophageal epithelium, which can present with both acute and chronic inflammatory features.
- Graft-versus-host disease (GVHD): In patients who have undergone bone marrow or stem cell transplantation, GVHD can affect the esophagus, leading to inflammation that may have both acute and chronic components.