"Cobblestone" Appearance of Esophagus: An Unusual Symptom of Pyloric Stenosis.

e A 3-month-old girl was admitted for suspected upper gastrointestinal (GI) tract bleeding and emesis. She had 3 weeks of regurgitation and 3 days of daily emesis, t weight from the 50th to the 25th percentile. Omeprazole was started on admission. doscopy revealed a ‘‘cobblestone’’ appearance of the esophagus (Fig. 1). Biopsies revealed severe esophagitis (no eosinophils) with ulceration and partial necrosis of the mucosa in the distal esophagus. Upper GI series revealed an enormous stomach with suspicion of infantile hypertrophic pyloric stenosis, confirmed by sonography. She underwent open pyloroplasty with no further emesis and regained her weight quickly. Repeat upper endoscopy at 12 weeks revealed a completely normal esophagus. Biopsies showed mild distal esophagitis. ‘‘Cobblestone esophagitis’’ is a rare endoscopic finding and has been associated with eosinophilic esophagitis, candidiasis, and Barrett esophagus in adults (1–3). It can also be found in severe reflux esophagitis secondary to distal GI obstruction, as in our case. Our patient had an atypical presentation of pyloric stenosis, with no history of projectile vomiting or persistent hunger (4).