Q:

A 40 year old woman complains of dysphagia for both solids and liquids. She sometimes suffers from severe retrosternal chest pain. Barium swallow reveals a dilated esophagus which tapers to a fine distal end. What is the best management strategy?

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A 40 year old woman complains of dysphagia for both solids and liquids. She sometimes suffers from severe retrosternal chest pain. Barium swallow reveals a dilated esophagus which tapers to a fine distal end. What is the best management strategy?


  1. Reassurance
  2. Antispasmodics
  3. Dilatation of the LES
  4. Endoscopic diverticulectomy
  5. Barium swallow

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The key is C. Dilatation of LES. [Dysphagia for both solids and liquids suggest neuromuscular dysphagia while dysphagia only for solid suggests mechanical obstruction. Here features are consistent with achalasia for which lower oesophageal sphincter dilation (balloon dilatation) is a treatment modality].

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