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Achalasia diagnostic confirmation — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Achalasia diagnostic confirmationUSMLE Step 3

A 60-year-old woman with obesity and gastroesophageal reflux disease presents with progressive dysphagia to solids and liquids, regurgitation of undigested food, and 12-lb weight loss. Barium esophagram shows a dilated esophagus with bird-beak narrowing at the gastroesophageal junction. Upper endoscopy shows no mass. Which of the following is the most appropriate next step in management?

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Correct answer: B — Esophageal manometry

Achalasia is suggested by dysphagia to solids and liquids plus bird-beak narrowing. Endoscopy excludes pseudoachalasia; manometry confirms diagnosis and characterizes subtype before definitive therapy.

Reference: American College of Gastroenterology Achalasia Guideline