A 45yr old man presented to the OPD dysphagia to both solid and liquids Esophageal manometry was performed = it revieled premature contraction with >20 % wet swallows and abnormally increased Lower esophageal pressure of >450mm hg
**Core Concept**
The patient's symptoms of dysphagia to both solids and liquids, along with esophageal manometry findings of premature contractions with >20% wet swallows and increased lower esophageal sphincter (LES) pressure, suggest a diagnosis of achalasia. Achalasia is a motility disorder characterized by the failure of the LES to relax, leading to impaired esophageal emptying and dysphagia.
**Why the Correct Answer is Right**
Achalasia results from the degeneration of myenteric neurons in the esophagus, leading to a loss of peristalsis and impaired LES relaxation. The premature contractions and increased LES pressure observed in this patient are hallmarks of achalasia. The increased LES pressure, in particular, is thought to result from the failure of the LES to relax in response to swallowing, leading to a "sphincter-like" effect that impedes the passage of food.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because the patient's symptoms and manometry findings do not suggest a diagnosis of diffuse esophageal spasm (DES), which is characterized by repetitive, simultaneous contractions of the esophageal body that are not associated with an increased LES pressure.
**Option B:** This option is incorrect because the patient's symptoms and manometry findings do not suggest a diagnosis of gastroesophageal reflux disease (GERD), which is characterized by symptoms of acid reflux and an abnormal relaxation of the LES in response to gastric distension.
**Option C:** This option is incorrect because the patient's symptoms and manometry findings do not suggest a diagnosis of scleroderma, which is characterized by esophageal dysmotility and an increased risk of esophageal strictures, but not typically by an increased LES pressure.
**Option D:** This option is incorrect because the patient's symptoms and manometry findings do not suggest a diagnosis of Zenker's diverticulum, which is characterized by a pharyngeal diverticulum that traps food, but not typically by an increased LES pressure.
**Clinical Pearl / High-Yield Fact**
Achalasia is often associated with a "bird's beak" appearance on barium swallow studies, which is due to the tapered appearance of the distal esophagus. This finding is a classic radiographic feature of achalasia.
**Correct Answer: C. Scleroderma**