Clinical VignetteQuestion 1 of 24
Chest Stuck Swallowing
A 46-year-old woman visits her primary care physician because, for the past 18 months, she has struggled to swallow every meal. She describes food "getting stuck somewhere in the middle of my chest" — and this problem started with both solid foods and liquids simultaneously from her very first symptomatic episode. She has never had a period when swallowing felt completely normal. She has lost 16 pounds, which she attributes to eating smaller portions to avoid the discomfort. She denies heartburn or any sour taste when food comes back up. On several occasions, food has returned to her mouth hours after eating as intact, undigested material with no acid or bitter taste. On examination, when she swallows a sip of water, there is no coughing, choking, or nasal regurgitation; the difficulty begins several seconds after she initiates the swallow and is localized to the lower chest.
Which of the following is the most likely diagnosis?