#INTERNAL_MEDICINE A 40 yo British woman presents with retrosternal chest pain that radiates to the back. There is associated difficulty swallowing, regurgitation, & heartburn. She did respond to calcium channel blocker and proton pump inhibitor. Her barium swallow x-ray is as shown below. What is the most likely diagnosis? A. Achalasia B. Angina pectoris C. Diffuse esophageal spasm D. Myocardial infarction

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C - Diffuse esophageal spasm

Diffuse esophageal spasm

C. Diffuse esophageal spasm ...Achalasia is unlike because the lower esophageal sphincter is located 3cm above the Gastro-esophageal junction the lower part does not look constricted. Myocardial infarction can not be determined by this type of diagnostic method...there should be other investigations...same for angina pectoris...but they are both part of DDx because symptoms of either conditions are not pathognomonic.

Diffuse esophageal spasm.. cork screw esophagus

C diffuse esophageal spasms.

Diffuse oesophageal spasm

Diffuse esophageal spasm

Manometry will suffice

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