Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with intermittent retrosternal chest pain and dysphagia to both solids and liquids. Symptoms are non-cardiac in nature, often triggered by stress, temperature extremes (hot/cold liquids), or rapid ingestion. Denies regurgitation of undigested food or significant weight loss. Pain episodes are described as squeezing or pressure-like, lasting from minutes to hours.
Clinical Examination Findings
General appearance: Patient is in no acute distress. HEENT: Oropharynx clear, no evidence of thrush or structural lesions. Cardiovascular: Regular rate and rhythm, no murmurs or rubs. Pulmonary: Clear to auscultation bilaterally. Abdomen: Soft, non-tender, non-distended, no palpable masses or organomegaly. Neurological: Cranial nerves II-XII intact.
Treatment Protocol
Initiate pharmacological therapy with calcium channel blockers (e.g., Diltiazem) or nitrates to reduce esophageal smooth muscle contraction. Consider tricyclic antidepressants (e.g., Nortriptyline) for visceral hypersensitivity. If refractory, evaluate for endoscopic botulinum toxin injection or pneumatic dilation. Advise small, frequent meals and avoidance of known temperature triggers.