iatroX Rounds #32
The clues
- 1
A 42-year-old man presents with a six-month history of difficulty swallowing both solids and liquids.
- 2
He notes that he often has to stand up, walk around while eating, or stretch his neck to help the food go down.
- 3
He frequently wakes up at night with a cough and finds undigested food on his pillow that does not taste acidic.
- 4
He describes intermittent, sharp retrosternal chest pain that can mimic a myocardial infarction.
- 5
A barium swallow study demonstrates a dilated proximal oesophagus with a smooth, symmetrical tapering at the gastro-oesophageal junction.
- 6
Oesophageal manometry reveals an elevated integrated relaxation pressure and a total absence of peristalsis in the distal oesophagus.
<p>This condition is a primary motor disorder of the oesophagus characterised by the failure of the lower oesophageal sphincter to relax upon swallowing (O'Neill et al., 2021). The underlying pathophysiology involves the progressive loss of inhibitory nitrergic neurons in the myenteric plexus (O'Neill et al., 2021). This loss results in an inability to coordinate distal oesophageal peristalsis (O'Neill et al., 2021).</p>
- <strong>Dysphagia:</strong> Progressive difficulty swallowing both solids and liquids from the onset (O'Neill et al., 2021).
- <strong>Regurgitation:</strong> Backflow of undigested food and saliva, particularly when lying flat at night (O'Neill et al., 2021).
- <strong>Chest Pain:</strong> Intermittent retrosternal discomfort that may be mistaken for cardiac pain (O'Neill et al., 2021).
- <strong>Radiology:</strong> A bird's beak appearance is often seen on contrast studies due to distal narrowing (O'Neill et al., 2021).
for education and entertainment. not medical advice.