Gastroenterology and Hepatologycommon
A 34-year-old woman describes 18 months of intermittent difficulty swallowing. From the beginning both liquids and solids have been affected, and it is worse when she is stressed. She has learned to eat slowly and to drink a glass of water to "push things down". Twice a week she wakes to find undigested food from the previous evening on her pillow, and she has had two episodes of a chesty cough after these nights. She has lost 4 kg. She has no heartburn. A barium swallow shows a dilated oesophagus that tapers smoothly to a narrow segment at the gastro-oesophageal junction, with delayed emptying of contrast into the stomach.
Which one of the following is the most likely diagnosis?