A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with captopril. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn with large doses of antacids, or omeprazole. Esophageal manometry is ordered. Most likely results of this test is ?

**Core Concept**
The patient's symptoms and medical history suggest a condition affecting the esophagus, possibly related to a systemic disease. The presence of Raynaud disease, facial telangiectasias, and taut skin suggests a diagnosis of **scleroderma**, a systemic disease that can affect the esophagus.

**Why the Correct Answer is Right**
In scleroderma, **esophageal dysmotility** is common due to fibrosis of the esophageal smooth muscle, leading to decreased lower esophageal sphincter (LES) pressure and impaired peristalsis. This can cause severe heartburn, which is resistant to conventional treatment with antacids or proton pump inhibitors like omeprazole. Esophageal manometry would likely show **low LES pressure** and **impaired esophageal peristalsis**.

**Why Each Wrong Option is Incorrect**
**Option A:** Would be incorrect as it doesn't directly relate to the symptoms and systemic disease suggested.
**Option B:** Might be considered but doesn't specifically address the esophageal dysmotility associated with scleroderma.
**Option C:** Could be a finding but doesn't encompass the full scope of esophageal involvement in scleroderma.
**Option D:** Is not the most accurate description of the expected manometry findings in this context.

**Clinical Pearl / High-Yield Fact**
Scleroderma can cause significant esophageal dysfunction, leading to severe, treatment-resistant heartburn. Recognizing the systemic manifestations of scleroderma is crucial for diagnosing and managing esophageal involvement.

**Correct Answer:** D. Low LES pressure with impaired esophageal peristalsis.

✓ Correct Answer: A. Decreased esophageal peristalsis and decreased LES pressure