Question

"A 44-year-old woman has a 10-year history of progressive dysphagia without pain. The dysphagia affects all kinds of food, without preference for solids. The food sticks in the xiphoid area and can be helped along by drinking large amounts of water and sitting up straight until the whole bolus passes into the stomach. She also describes many episodes of regurgitation of foul-smelling but undigested food, either when she leans forward or when she is asleep at night. She used to be heavier and lost weight as the disease progressed. A barium swallow shows a massively dilated proximal esophagus with a narrow, beak-like appearance in the lower sphincteric area.

Which of the following is the most likely original pathophysiology that explains the development of this problem?" A. Failure of the lower esophageal sphincter to relax
B. Reflux of acid gastric juice into the lower esophagus
C. Replacement of smooth muscle by fibrous tissue
D. Spasm of the lower esophageal sphincter
E. Weak or nonexistent peristaltic activity in the upper esophagus

Answer 1

The most likely original pathophysiology explaining the development of the woman's symptoms is a failure of the lower esophageal sphincter to relax, indicative of achalasia.

Step-by-step explanation:

The patient's symptoms suggest a condition where the lower esophageal sphincter (LES) fails to relax properly. This is characteristic of a disorder known as achalasia. In achalasia, the LES does not relax adequately during swallowing, which leads to a backup of food within the esophagus, a massively dilated proximal esophagus, and a beak-like narrowing at the gastroesophageal junction as observed during a barium swallow test. This condition can lead to difficulty swallowing (dysphagia), regurgitation, and potentially weight loss as seen in this patient's 10-year history of progressive symptoms.

The most likely original pathophysiology explaining the development of this patient's problem is A. Failure of the lower esophageal sphincter to relax. Achalasia could result in the described regurgitation of undigested food and the sensation that food is sticking in the xiphoid area.