A 16-year-old female presented to the clinic complaining of progressive worsening of dysphagia to solid foods with sensation of fullness in the chest and sour taste in the mouth but denies heartburn or chest pain. She did not have any weight loss. Her symptoms were unresponsive to PPI therapy started by her primary care physician. There was no family history of gastric cancer. The physical exam was unremarkable and the blood work was normal (including celiac panel, comprehensive metabolic panel, and HP IgG). An esophagram was normal. She underwent esophagogastroduodenoscopy (EGD), which revealed a 4 mm prepyloric nodule (see Figure 1(a)). A rapid urease test for HP was negative. Hematoxylin and eosin-stained sections on the prepyloric nodule biopsy showed antral-type gastric mucosa (see Figures 1(b) and 1(c)). The lamina propria was distended by a chronic inflammatory cell infiltrate consisting of lymphocytes and plasma cells. Numerous mucin producing cells, characteristic of intestinal epithelium, were identified. The features were those of chronic gastritis with intestinal metaplasia of the complete type. No dysplasia was present. No HP organisms were identified on light microscopy and by immunostain. Patient reports improvement in her symptoms after completing a course of double dose PPI therapy. Repeated EGD 1 year after showed resolution of the gastric erosion and persistence of the prepyloric nodule on EGD. Complete type intestinal metaplasia persisted on histologic evaluation.