High oesophageal stricture with hiatal hernia and a lower oesophagus lined by columnar epithelium.

A 23-year-old man with a six months' history of dysphagia was found to have hiatus hernia with reflux and a stricture of the mid-oesophagus. Death from unrelated causes permitted detailed histological examination. This showed a high squamo-columnar junction with ulceration confined to the squamous epithelium immediately above the junction. The columnar epithelium of the lower oesophagus was largely of cardiac type, but a few gastric body type glands were present at the lowermost end. This mixed pattern and the complete lack of inflammation or fibrosis beneath the columnar epithelium favours a congenital rather than metaplastic origin. A high squamocolumnar junction is of clinical significance only in the presence of reflux when oesophagitis and stricture develop at an unusually high level.