Dysphagia to solids first then liquids (374/1700)

A pt presents with longstanding gastric reflux, dysphagia and chest pain. On barium enema, dilation of esophagus with tapering end is noted. He was found with Barrett’s esophagus. He had progressive dysphagia to solids and then liquids. What is the single most appropriate dx?

a. Achalasia
b. Esophageal spasm
c. GERD
d. Barrett’s esophagus
e. Esophageal carcinoma

Answer C

They state the histology is barret’s esophagus (not adenocarcinoma), so it would be illogical to choose esophageal carcinoma. No reflux symptoms in achalasia because the LES pressure is very high. It would seem to be best described as severe GERD complicated with stricture and barret’s esophagus.