Chronic gastroesophageal reflux disease

A 55-year-old woman with chronic gastroesophageal reflux disease (GERD) presents with dysphagia to solids but not to liquids. Endoscopy shows esophageal strictures.

What is the most likely underlying cellular change?

A) Hyperplasia
B) Dysplasia
C) Atrophy
D) Metaplasia
E) Hypertrophy

Correct Answer:

D) Metaplasia

Explanation:

• Chronic acid reflux (GERD) → Squamous epithelium of the esophagus transforms into columnar epithelium → Barrett’s esophagus (intestinal metaplasia).
• Hyperplasia (A) is an increase in cell number but does not involve a change in cell type.
• Dysplasia (B) is a precancerous change that may follow metaplasia.
• Atrophy (C) is shrinkage of tissue, not a change in type.
• Hypertrophy (E) is increase in cell size, not a transformation of cell type.

Key Tips for PLAB 1:

✅ GERD → Metaplasia (Barrett’s esophagus: squamous → columnar epithelium)
✅ Metaplasia can progress to dysplasia and adenocarcinoma
✅ Management = PPI therapy, endoscopic surveillance