A patient has solids and liquids difficulty, regurgitation hours after eating, complete loss of peristalsis on imaging, and a nonrelaxing lower esophageal sphincter preventing bolus passage to the stomach. The diagnosis is which condition?

• A. Trismus
• B. Achalasia
• C. Luminal Deformity
• D. Extrinsic Compression

Answer: (B)

This pattern is a motor issue of the esophagus: loss of coordinated movement with failure of the lower esophageal sphincter to relax.

When both solids and liquids cause trouble from the start, it points to a problem with esophageal motility rather than a fixed narrowing. Regurgitation hours after meals happens because food stays in a dilated, nonpropulsive esophagus, leading to backflow rather than a blocked bolus passing into the stomach. The imaging finding of complete loss of peristalsis in the body of the esophagus along with a nonrelaxing LES that prevents bolus passage to the stomach is the classic combination for achalasia.

Trismus is unrelated to esophageal passage. Luminal deformities like strictures or rings typically present after solids and with different obstruction patterns, and extrinsic compression would cause a mechanical narrowing pattern rather than the described motility failure.