ROSH Gastrointestinal Practice Exam

If untreated, which complication is most likely to develop in a patient with a burning sensation in his chest and nocturnal cough?

1. Esophageal adenocarcinoma

2. Hepatocellular carcinoma

3. Small cell carcinoma of the lung

4. Squamous cell carcinoma of the esophagus

The correct answer is: Esophageal adenocarcinoma

The correct answer is that untreated conditions leading to chronic gastroesophageal reflux disease (GERD) can predispose a patient to esophageal adenocarcinoma. When a patient experiences symptoms such as a burning sensation in the chest (indicative of heartburn) and a nocturnal cough (which may suggest aspiration of gastric contents), these symptoms often correlate with recurrent acid reflux. Over time, persistent exposure to stomach acid can lead to changes in the esophageal lining, especially in the lower esophagus. This condition, known as Barrett's esophagus, involves the replacement of the normal squamous epithelium with columnar epithelium, which increases the risk of developing esophageal adenocarcinoma. Therefore, if a patient’s GERD symptoms remain untreated, the likelihood of developing esophageal adenocarcinoma can significantly increase. In contrast, the other potential options relate to different conditions or malignancies not directly associated with the symptoms described. Hepatocellular carcinoma is primarily linked to liver diseases and would not be a direct complication of GERD. Small cell carcinoma of the lung and squamous cell carcinoma of the esophagus are related to different risk factors and symptomatology that does not align with the presented symptoms of GERD