Answer to the last #DiagnosticDilemma
Correct answer is C, Eosinophilic esophagitis.

Upper endoscopy revealed prominent mucosal rings extending 20 cm from the incisors to the level of the gastroesophageal junction, with two discrete areas of narrowing and associated linear furrows.

Biopsy specimens were obtained, and esophagitis was observed, with more than 40 eosinophils per high-power field. An endoscopic finding of fixed esophageal rings, or "trachealization," is suggestive of eosinophilic esophagitis, although a definitive diagnosis is made on the basis of clinical presentation, histologic findings, and the exclusion of other causes of esophageal eosinophilia, such as proton-pump inhibitor-responsive esophageal eosinophilia.

The patient was treated with an 8-week course of omeprazole, but there was no symptom resolution or histologic improvement on repeat endoscopic biopsies, which confirmed the diagnosis of eosinophilic esophagitis.

Source: https://www.nejm.org/image-challenge
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