1. impaired esophageal peristalsis & LES stenosis
   1. dt
      1. nerve degeneration
   2. progressive
      1. liquids and solids
2. Presentation
   1. food regurg
      1. esp. at night
         1. pt uses multiple pillows or sleeps upright
   2. chest pain
      1. retrosternal
      2. radiates
         1. neck, jaw, arms, back
      3. mb worse with food & stress
   3. 20-40 y.o.
3. risk factor
   1. recurrent brochopneumonia
4. Physical Exam
   1. Halitosis
   2. Wt Loss
5. Imaging
   1. X-ray
      1. beak dilation
   2. Manometry
   3. Barium swallow