A 45 year old man says that for the past year he occasionally has regurgitated food particles eaten several days earlier. His wife complains that his breath has been foul smelling. He has had occasional dysphagia for solid foods. The most likely diagnosis is
a. Gastric outlet obstruction
b. Scleroderma
c. Achalasia
d. Zenker's diverticulum
e. Diabetic gastroparesis
Answer and explanation
a. Gastric outlet obstruction
b. Scleroderma
c. Achalasia
d. Zenker's diverticulum
e. Diabetic gastroparesis
Answer and explanation
The answer is d.
A Zenker's diverticulum typically causes halithosis(bad breath) and regurgitation of saliva and food particles consumed several days earlier. When a zenkers diverticulum fills with food, it may produce dysphagia by compressing the esophagus.
Gastric outlet obstruction can cause bloating and regurgitation of newly ingested food.
Gastrointestinal disorders associated with scleroderma include esophageal reflux, the development of wide-mouthed colonic diverticulosis, and stasis with bacterial overgrowth.
Achalasia typically presents with dysphagia for both solids and liquids.
Gastric retention caused by autonomic neuropathy of diabetes mellitus usually results in postprandial epigastric discomfort and bloating.
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