For the past several months, a 43-year-old man has been evaluated for retrosternal discomfort and dysphagia. He smokes a pack of cigarettes every day and consumes alcohol on weekends. His body mass index (BMI) is 32.8 kg/m². The physical exam is unremarkable. Esophageal manometry is performed; the tracings appear as shown in the image below after a single swallow of 5 mL of water. Which of the following is the most likely diagnosis in this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Achalasia is caused by a decrease in inhibitory ganglion cell numbers in the esophageal wall. In achalasia, esophageal manometry reveals a decreased amplitude of peristalsis in the mid esophagus, as well as increased tone and incomplete relaxation at the lower esophageal sphincter.

For the Past Several Months, a 43-Year-Old Man Has Been