A 33-year-old Caucasian male presents to your office and complains that solid food 'sticks in the chest.' He says that he has to chew food more carefully, take more liquids with meals, and swallow small portions. He recalls having a similar episode several months ago that got better after 'following a diet', but it was much less severe. He has had periodic chest pain behind the sternum for the last several years. He denies any recent significant weight loss, abdominal pain, nausea, vomiting, diarrhea/constipation, black stools and neck lumps. He smokes one pack of cigarettes daily and consumes alcohol occasionally. He is currently not taking any medications. Which of the following is the most likely diagnosis in this patient?

Question

A 33-year-old Caucasian male presents to your office and complains that solid food 'sticks in the chest.'  He says that he has to chew food more carefully, take more liquids with meals, and swallow small portions.  He recalls having a similar episode several months ago that got better after 'following a diet', but it was much less severe.  He has had periodic chest pain behind the sternum for the last several years.  He denies any recent significant weight loss, abdominal pain, nausea, vomiting, diarrhea/constipation, black stools and neck lumps.  He smokes one pack of cigarettes daily and consumes alcohol occasionally.  He is currently not taking any medications.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Explanation: It is important to identify the non-classical presentations of GERD, including periodic retrosternal chest pain that can mimic angina. The resulting erosive esophagitis may cause transitory dysphagia, which may result in a peptic stricture if left untreated. Peptic stricture formation is a well-known complication of GERD that can cause obstructive dysphagia. In this case, the typical clinical picture of obstructive dysphagia is given: difficulty swallowing solid food, prolonged and careful chewing, and swallowing small portions. (Choices A and B)Malignancies can cause obstructive dysphagia; however, the following information from the patient's history do not support this diagnosis: (1) young age, (2) absence of weight loss, and (3) previous history of GERD and GERD-induced stricture. (Choice C)Achalasia usually causes dysmotility-type dysphagia that is characterized by a difficulty in swallowing both solids and liquids. (Choice D)Barrett's esophagus is a pre-malignant complication of GERD. It does not cause dysphagia. Educational Objective: Peptic stricture is a well-known complication of GERD that results from the healing process of ulcerative esophagitis. Dysphagia usually starts with solids followed by liquids. Young age and lack of alarming symptoms argue against a diagnosis of malignancy.

A 33-Year-Old Caucasian Male Presents to Your Office and Complains That Solid