Snapshot A 72-year-old obese woman presents to her primary care physician with intermittent chest pain and difficulty swallowing liquids and solid foods. Cardiac work up including electrocardiogram, cardiac enzymes, and coronary angiography is normal. She undergoes barium swallow radiography, which was normal. Further testing with esophageal manometry shows 182 mmHg of pressure created by the esophagus during peristalsis. Introduction Clinical definition login to view 2 more bullets Associated conditions login to view 3 more bullets Epidemiology Any age but more common in 60-70s ETIOLOGY Pathogenesis login to view 2 more bullets Presentation Symptoms login to view 3 more bullets Physical exam login to view 1 more bullet imaging Upper gastrointestinal barium swallow login to view 2 more bullets Other studies login to view 6 more bullets Studies Diagnostic testing login to view 2 more bullets Differential Achalasia login to view 2 more bullets Diffuse esophageal spasm login to view 2 more bullets Angina and acute coronary syndrome login to view 4 more bullets Treatment Risk factor modification login to view 1 more bullet First-line login to view 4 more bullets Interventional login to view 5 more bullets Complications Food bolus obstruction