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Gastroenterology


Answer 5
  1. Achalasia. The patient has dysphagia to both solids and liquids, which suggests a motility disorder rather than a mechanical or obstructive process such as a tumor or ring. Zenker’s diverticulum, a cricopharyngeal outpouching that can trap food, could produce some of the symptoms seen in this patient (ie, regurgitation) but would be unlikely to cause such profound dysphagia, especially to liquids. Zenker’s diverticulum is often associated with aspiration pneumonia, which this patient does not have. In patients with achalasia, the esophagus becomes aperistaltic and the lower esophageal sphincter fails to relax with swallowing. This produces significant dysphagia to solids and liquids as well as trapping of food in the esophagus that often leads to regurgitation, especially when recumbent.

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