Dysphagia, narrow LES (272/1700)

A 60yo woman presented to OPD with dysphagia. No hx of weight loss of heartburn. No change
in bowel habits. While doing endoscopy there is some difficulty passing through the LES, but no
other abnormality is noted. What is the single most useful inv?

a. CXR
b. MRI
c. Esophageal biopsy
d. Esophageal manometry
e. Abdominal XR



























answer: D

Achalasia
Inflammatory degeneration of Auerbach’s plexus
increase in LES pressure,
incomplete relaxation of LES with swallowing, aperistalsis

  • CXR: no air in stomach, dilated esophagus
  • Barium studies: esophagus terminates in narrowing at LES ("bird’s beak")
  • Endoscopy: rule out malignancy
  • Manometry:  definitive diagnosis

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