Differential Diagnosis for Dysphagia with Abnormal Distal Contractile Integral (DCI) on LOS Manometric Study

• Single most likely diagnosis:
  • Achalasia cardia: This condition is characterized by the failure of the lower esophageal sphincter (LES) to relax, leading to dysphagia. An abnormal DCI can indicate impaired contractility, which is consistent with achalasia.
• Other Likely diagnoses:
  • Diffuse oesophageal spasm: This condition involves uncoordinated muscle contractions of the esophagus, which can cause dysphagia and chest pain. An abnormal DCI might reflect the disordered motility.
  • Scleroderma: This autoimmune disease can lead to esophageal dysmotility, including a decrease in the contractile force of the esophagus, which could be indicated by an abnormal DCI.
• Do Not Miss diagnoses:
  • Esophageal cancer: Although less likely, esophageal cancer can cause dysphagia and abnormal manometric findings due to mechanical obstruction or infiltration of the esophagus. Missing this diagnosis could be fatal.
  • Chagas disease: This parasitic infection can lead to achalasia-like symptoms due to destruction of the myenteric plexus of the esophagus. It's crucial not to miss this diagnosis, especially in endemic areas.
• Rare diagnoses:
  • Eosinophilic esophagitis: This condition, characterized by an eosinophilic infiltration of the esophagus, can cause dysphagia and might affect esophageal motility, although it's less commonly associated with abnormal DCI on manometry.
  • Nutcracker esophagus: This rare condition involves very powerful esophageal contractions that can cause chest pain and dysphagia. While it might show abnormal manometric findings, it's less likely to be associated with the specific pattern of an abnormal DCI indicative of a motility disorder like achalasia.