Endoscopy reveals a stricture of the esophagus at 39 cm from the incisors. He also notes frequent regurgitation of undigested food 12 to 36 hours after meals. He has a repetitive cough in supine position and has had three episodes of aspiration pneumonia. She states that initially there was pain with swallowing but that this is now resolved. Barium swallow reveals a markedly dilated esophagus terminating a narrowed segment near the GE junction.
Physical exam reveals cervical tenderness and crepitance.
A chest x-ray shows widening of the superior anterior displacement of the trachea. An upper GI study reveals a para-esophageal hiatal hernia. He was admitted to a coronary care unit where an angiogram showed a normal cardiac vasculature. A stress EKG and cardiac enzymes were normal. This was his third attack in three months.