A 32-Year-Old Man Comes to the Office Due to Intermittent

question 220

Multiple Choice

A 32-year-old man comes to the office due to intermittent dysphagia for solids and liquids.  He has no significant past medical history and does not use tobacco, alcohol, or illicit drugs.  His father has a history of esophageal squamous cell carcinoma.  Physical examination is unremarkable.  The patient undergoes an esophageal manometric study that demonstrates periodic, simultaneous, and non-peristaltic contractions of large amplitude and long duration.  Which of the following is the most likely pathogenesis of this patient's esophageal condition?

• A)Disruption of the gastroesophageal junction
• B)Eosinophil infiltration
• C)Impaired neural inhibition
• D)Mucosal outpouching through a muscular wall defect
• E)Obstruction from unregulated cell growth
• F)Smooth muscle atrophy and gut wall fibrosis

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