A 74-Year-Old Man Comes to the Office Due to Several

A 74-year-old man comes to the office due to several months of choking spells, dysphagia, and cough.  He has also had recurrent episodes of pneumonia.  His other medical problems include hypertension and osteoarthritis.  Blood pressure is 130/70 mm Hg.  The patient has foul-smelling breath, but his oropharyngeal and neck examinations are normal.  Cardiopulmonary examination is also normal.  A barium swallow study is performed and reveals an abnormality in the upper esophagus, as shown in the image below. Which of the following mechanisms is the most likely cause of his symptoms?

A) Cricopharyngeal motor dysfunction
B) Degenerative changes of the myenteric plexus
C) Increased intraluminal pressure in the stomach
D) Retention cyst due to duct obstruction
E) Scarring and traction of the esophagus

Correct Answer:

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