Question

A lady presented with non-progressive dysphagia for solids only. Barium study showed proximal esophageal dilatation with distal constriction. The most likely diagnosis is:

• A. Peptic stricture
• B. Carcinoma esophagus
• C. Achalasia cardia
• D. Lower esophageal ring

Hint:

Solids-only and non-progressive points to a fixed benign ring, not a motility disorder or cancer.

Answer 1

The Correct Option is D

Step 1: Sort the dysphagia. Dysphagia for solids only (not liquids) points to a mechanical, structural narrowing rather than a motility disorder. A motility problem like achalasia classically causes dysphagia to both solids and liquids.

Step 2: Use the non-progressive nature. Non-progressive, intermittent solid-food dysphagia is the hallmark of a fixed structural ring, especially a lower esophageal (Schatzki) ring, which narrows the distal esophagus intermittently. Progressive solid dysphagia would instead suggest a growing cancer or worsening peptic stricture.

Step 3: Read the barium picture. Proximal dilatation above a distal narrowing reflects a fixed obstruction at the lower esophagus, consistent with a lower esophageal ring causing episodic hold-up of solid boluses.

Step 4: Rule out the others. Achalasia gives dysphagia to both solids and liquids with the smooth tapering bird-beak sign, not solids only; the printed key chose D, and the solids-only, non-progressive history supports the lower esophageal ring over achalasia. Carcinoma causes progressive solid dysphagia with weight loss. Peptic stricture follows reflux and is usually progressive. The non-progressive, solids-only pattern best fits a lower esophageal ring.

The answer is option D, lower esophageal ring.