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Question

Difficulty: EasyGastroenterology and Hepatology

Match each classic esophageal disorder with its characteristic finding on esophageal manometry or upper endoscopy.

  • AchalasiaIncomplete lower esophageal sphincter relaxation and absent peristalsis
  • Diffuse esophageal spasmSimultaneous, uncoordinated, non-peristaltic contractions with normal sphincter tone
  • Systemic sclerosis (Scleroderma)Decreased lower esophageal sphincter tone and absent peristalsis in the lower esophagus
  • Eosinophilic esophagitisMultiple corrugated rings (trachealization) and linear furrows seen on endoscopy

Answer

Achalasia matches with incomplete sphincter relaxation; Diffuse esophageal spasm matches with uncoordinated contractions; Systemic sclerosis matches with decreased sphincter tone; Eosinophilic esophagitis matches with corrugated rings.
Each esophageal disorder has distinct pathophysiologic mechanisms that dictate its diagnostic findings. Achalasia represents a failure of relaxation due to ganglionic loss. Systemic sclerosis represents muscle atrophy leading to a patulous, weak sphincter. Diffuse esophageal spasm is a hypermotility state with normal sphincter function. Eosinophilic esophagitis is an immune-mediated structural disease visible on endoscopy.

Step-by-Step Solution

1
Evaluate the motor dysfunction involving failure of relaxation.
Achalasia pairs with incomplete lower esophageal sphincter relaxation.
Loss of inhibitory neurons in the myenteric plexus prevents the sphincter from relaxing during swallowing.
2
Identify the hypermotility disorder.
Diffuse esophageal spasm pairs with simultaneous, uncoordinated contractions.
Premature and uncoordinated contractions occur despite normal sphincter relaxation, classically causing 'corkscrew' appearance on imaging.
3
Identify the fibrotic disease causing smooth muscle replacement.
Systemic sclerosis pairs with decreased sphincter tone.
Collagen deposition and smooth muscle atrophy leave the lower esophagus essentially paralyzed and the sphincter permanently open, risking severe reflux.
4
Evaluate the inflammatory condition diagnosed visually or histologically.
Eosinophilic esophagitis pairs with corrugated rings.
Chronic allergic inflammation leads to structural remodeling, producing trachealization of the esophagus.

Key Concept

Pathophysiology and diagnostics of esophageal motility and inflammatory disorders
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Topics

Gastroenterology and Hepatology

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