{"ops":[{"insert":"A 52 year old woman presents with slowly worsening, intermittent \u0027burning\u0027 chest pain for 1 year. There is no radiation, and the pain is not exacerbated by exertion.\n\nShe was prescribed a two-week course of Omeprazole by her primary care physician approximately a month ago. However, her symptoms remained unchanged.\n\nClose questioning reveals the presence of mild dysphagia to both solids and liquids, for several months, which was mainly felt in the upper chest. She also lost 5 kg of weight during the past half-year.\n\nHer medical history is significant for uncomplicated mild hypertension for 4 years, which is well controlled on Amlodipine 10 mg daily. No other comorbidities are present.\n\nShe has never smoked, and only drinks socially. A complete blood count, two 12-lead ECGs, and an exercise stress test have been ordered recently, all of which were normal.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-050_en.png"}},{"insert":"\n"}]}
2
Investigate
Upper GI Endoscopy
{"ops":[{"insert":"The esophagus appears normal. The gastroesophageal junction is difficult to traverse and only opens after multiple attempts. The stomach and duodenum appear normal.\n"}]}
Esophageal Manometry
{"ops":[{"insert":"There is impaired relaxation of the lower esophageal sphincter (LES), during deglutition. The basal esophageal pressure is 62 mmHg (normal: \u003C 45). There is aperistalsis in the distal two-thirds of the esophagus.\n"}]}
