Page 1 of 2: A 40-year-old man presents with dysphagia

dinaridi · Credits: 2770 My Scrapbook

Question: 4
A 40-year-old man presents with dysphagia, which appears to be much worse for cold food as compared to warm food and worse for liquids than for solids. He has also experienced regurgitation of food, especially at night. Esophagrams showed smooth narrowing of the cardioesophageal junction and dilation of the esophagus proximal to the area of narrowing. Which one of the following is the most likely diagnosis?
1) carcinoma of the esophagus
2) peptic esophagitis
3) achalasia
4) diffuse spasm of the esophagus
5 benign esophageal stricture

met5 · Credits: 1470 My Scrapbook

4) lacunar infarction

met5 · Credits: 1470 My Scrapbook

oops sorry, 3) achalasia

ruks83 · Credits: 1504 My Scrapbook

haha i got scared reading yr answer initially met 5

yea i agree achalasia

DRelsadig · Credits: 1509 My Scrapbook

it gets worst with cold foods
it is DES

smartyroy · Credits: 13510 My Scrapbook

3... achalasia

maryana · Credits: 7531 My Scrapbook

I would say achalasia, but what about response to different temperatures food?

bloater · Credits: 800 My Scrapbook

Tempted answer is 3) but cold food sensitivity is not explained.

bloater · Credits: 800 My Scrapbook

Reviewed Achalasia and DES.
In Achalasia, there is no food selectivity in making the symptom 'dysphagia'. But in DES, hot food makes dysphagia worse. When DES progresses, the esophageal Pathology becomes something like Achalasia. So, in this question, if the cold sensitivity be exchanged to 'hot sensitivity', DES will be an answer.

maryana · Credits: 7531 My Scrapbook

Yes..thisresponse to different food temperatures bothers me...so I think I would mark DES.

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