In a 45-year-old woman with a history of arthritis experiencing severe heartburn and indigestion refractory to antacids, which findings on an esophageal manometry study are consistent with her diagnosis?

Correct Answer: C

Rationale: The correct answer is C: Absent peristalsis and decreased LES pressure. In a patient with severe heartburn and indigestion refractory to antacids, these findings are consistent with achalasia, a motility disorder characterized by impaired esophageal peristalsis and decreased LES pressure. Absent peristalsis leads to poor esophageal clearance and retention of food, causing symptoms like heartburn. Decreased LES pressure results in inadequate closure of the LES, leading to reflux of gastric contents into the esophagus. Choices A, B, and D are incorrect because they do not match the typical findings seen in achalasia. Vigorous peristalsis and elevated LES pressure are not consistent with achalasia, while absent peristalsis with increased LES pressure is not a common presentation.

Correct Answer: B

Rationale: The correct answer is B: Proton pump inhibitor. In this case, the patient's symptoms of chest pain, dysphagia to solids and liquids, and indigestion suggest possible gastroesophageal reflux disease (GERD). A proton pump inhibitor helps reduce gastric acid production, alleviating symptoms and potentially healing any esophageal damage caused by reflux. This is the most appropriate initial therapy as it targets the underlying cause. A: Sucralfate is a cytoprotective agent that may help with mucosal protection but does not address acid suppression, which is crucial in GERD. C: Prokinetic agents enhance gastrointestinal motility and are not the first-line treatment for GERD. D: Benzodiazepines are not indicated for the treatment of GERD and do not address the underlying acid reflux issue.

Correct Answer: D

Rationale: The correct answer is D: Calcium channel blocker. Odynophagia is often associated with esophageal ulcers, which can be exacerbated by NSAIDs (A) due to their effect on the gastric mucosa. Alendronate (B) is a bisphosphonate used to treat osteoporosis and can cause esophagitis. Iron sulfate (C) can also irritate the esophagus. However, calcium channel blockers (D) are least likely to contribute to esophageal ulcers or odynophagia as they do not directly affect the esophagus or increase the risk of ulcers.

Correct Answer: B

Rationale: The correct answer is B: Endoscopic balloon dilatation. This is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR because these symptoms suggest achalasia, a motility disorder of the esophagus. Endoscopic balloon dilatation helps to disrupt the lower esophageal sphincter muscle, relieving symptoms and improving esophageal emptying. Proton-pump inhibitors (A) are used for acid-related conditions, not for achalasia. Sucralfate (C) is a mucosal protective agent and not indicated for achalasia. Esophageal resection (D) is a more invasive option and usually reserved for severe cases or when other treatments have failed.

Correct Answer: B

Rationale: The correct answer is B: Irritable bowel syndrome (IBS). The key clues in the question are chronic constipation, bloating, abdominal pain relieved with defecation, and absence of alarming symptoms. These symptoms align with the Rome IV criteria for IBS. Inflammatory bowel disease (A) typically presents with more severe symptoms, including weight loss and blood in stools. Celiac disease (C) is associated with malabsorption symptoms and autoimmune features, not typically seen in this case. Lactose intolerance (D) presents with symptoms after consuming dairy, which is not mentioned in the patient's history. Therefore, based on the clinical presentation and exclusion of other conditions, the most likely diagnosis is IBS.