A 39-Year-Old Man Has from Chest Pain When He Eats

Short Answer

A 39-year-old man has from chest pain when he eats, especially meat. He also belches excessively and has heartburn. His wife complains about his bad breath. The radiograph shows a dilated esophagus, and achalasia is suspected. Esophageal manometry confirms the diagnosis. Which one of the pressure tracings given below was taken at the lower esophageal sphincter of this patient before and after swallowing (arrow)? The dashed line represents a pressure of 0 mm Hg.