Question 10#

A 65-year-old woman with a complex medical history (including diabetes, hypertension, coronary artery disease, gastroesophageal reflux disease, and ongoing use of alcohol and tobacco) presents with increasing midsternal chest discomfort predominantly when swallowing solid food. Recently, even liquids are becoming problematic. She has not noted blood in her stool or melena, weight loss, or change in her energy level.

What is the most likely cause of her dysphagia?

a. Esophageal cancer
b. Peptic esophageal stricture
c. Achalasia
d. Zenker diverticulum
e. Polymyositis

Correct Answer is B


Peptic strictures due to chronic, persistent acid reflux cause 80% of esophageal strictures. Diagnostic esophagogastroduodenoscopy followed by dilation is necessary to relieve the dysphagia; the procedure may need to be repeated from time to time as symptoms recur. A patient with esophageal cancer is likely to have weight loss. Patients with achalasia often regurgitate undigested food; achalasia is less common than peptic stricture. A Zenker diverticulum is an outpouching in the posterior wall of the hypopharynx, which allows food retention, causing halitosis, recurrent aspiration, and pneumonia. While patients with polymyositis often have dysphagia, they would typically display weakness of the proximal muscles in addition to dysphagia.