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A 65 yr old man comes to the officewitha 2 month hx of dysphagea.He initially had difficulty swallowing solids but now this includes liquids.he has occasional heart burn,which usually respond well to antacids.He has lost 30 to 40 pound of wt in the past 2 months.He has 40 pack yr hx of smoking.He has been chronic alcoholic for 20 yrs.His temperature is 98F,BP is 110/80,pulse is 66/ min and respirations are 14/min.Physical exam show no abnormalities.Barium studdies show a minimally dilatedesophagus with BEAK-Shaped narrowing.The upper GI endoscope is unable to pass thru lower Esoph.sphincter.Manometery shows increased lower Esoph.sphincter tone.Which of the following is most likely Dx?

A-Achalasia
B-Scleroderma
C-Esophageal cancer
D-Peptic stricture
E-Diffuse Esophageal spasm

aaa

A achlasia

aaaaaaaaa - parrot beak

AA

C

Is it possible to lose 30-40 pounds in Achalasia???

C-Esophageal cancer

Carcinoma starts with solid dysphagia then progress to liquid

AAAA Achalasia leading to adenocarcinoma...

GERD ("heartburns") which then transformated into adenocarcinoma.
CCC