Esophageal disorders Quiz: Ace Your Exams

A 65-year-old woman comes to the clinic due to difficulty swallowing and retrosternal pain. For the past 2 days, she has had pain with swallowing which has progressively worsened to the point of avoiding all food and drinks. She has not had similar symptoms in the past. Medical history is significant for coronary artery disease, hyperlipidemia, seasonal allergies, and osteoarthritis. The patient has smoked 1 pack of cigarettes per day for 30 years. Medications include aspirin, metoprolol, loratadine, lovastatin, and piroxicam as needed. Temperature is 37.0°C (98.6°F), pulse is 80/min, and blood pressure is 125/85 mmHg. The oral mucosa is clear without erythema or exudate. Cardiac auscultation reveals no murmurs, and ECG shows normal sinus rhythm without ischemic changes. The rest of the physical examination is normal. Endoscopy is obtained and shows multiple round ulcers in the mid-esophagus with relatively normal surrounding tissue. Which of the following is the most likely diagnosis?