Differential Diagnosis for Dysphagia with LOS Manometric Study Showing DCI 400

• Single most likely diagnosis:
  • Achalasia cardia: This condition is characterized by the failure of the lower esophageal sphincter (LES) to relax, leading to dysphagia. A high distal contractile integral (DCI) value, such as 400, can be seen in achalasia due to the increased contractility of the esophageal body in an attempt to overcome the non-relaxing LES.
• Other Likely diagnoses:
  • Diffuse oesophageal spasm: This condition involves abnormal, uncoordinated muscle contractions of the esophagus, which can cause dysphagia and chest pain. While the DCI value can be elevated, it might not always reach as high as 400, but it remains a consideration given the symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • None specifically stand out as "do not miss" diagnoses that are both unlikely and potentially deadly in this context, given the information provided. However, conditions like esophageal cancer or stricture could cause dysphagia and should be considered in the broader differential diagnosis, especially if other symptoms or risk factors are present.
• Rare diagnoses:
  • Scleroderma: While scleroderma can involve the esophagus and cause dysphagia due to fibrosis and decreased motility, it typically presents with a low DCI due to decreased esophageal contractility, making it less likely given the high DCI value of 400 in this scenario.