A 32-year-old woman with a history of Raynaud phenomenon and skin tightening develops progressive dysphagia to solids. Barium swallow shows a dilated esophagus with a bird-beak appearance at the lower end. The most likely diagnosis is:

• A Achalasia
• B Systemic sclerosis (scleroderma) ✓
• C Diffuse esophageal spasm
• D Esophageal adenocarcinoma

Explanation

Systemic sclerosis involving the esophagus causes smooth muscle atrophy and fibrosis, leading to a patulous lower esophageal sphincter with reflux and distal stricturing. The bird-beak appearance on barium swallow combined with Raynaud phenomenon and skin tightening is characteristic of scleroderma. Achalasia shows absent peristalsis and failure of LES relaxation but lacks skin findings.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.