Which part of oesophagus is mainly affected in scleroderma?

Ans. c (Lower third). (Ref. Harrison, Medicine, 18th/Ch. 292. Diseases of the Esophagus)In Scleroderma esophagus there is hypotensive LES and absent esophageal peristalsis, which predispose patients to severe GERD due to inadequate LES barrier function combined with poor esophageal clearance of refluxed acid.FEATURE OF FEW ESOPHAGEAL DISEASESAExaggerated Tertiary esophageal contractions(Presbyesophagus, diffuse esophageal spasm, neuromuscular diseases)."Yo-Yo" motion of barium."Corkscrew" appearance (scalloped configuration of barium column)."Rosary-bead/shish kebab" configuration (compartmentalization of barium column).Manometry is investigation of choice for mortality disorders .BFeline oesophagus (transient contraction of longitudinally oriented muscularis mucosae)Normal variant.Gastroesophageal reflux disease.CDouble-barrel esophagusDissecting intramural hematoma.Mallory-Weiss tear.Intramural abscess.Intraluminal diverticulumDAchalasia cardia.Megaesophagus/sigmoid esophagus."Bird beak" deformity.Absence of primary peristalsis below level of cricopharyngeus.Hurst phenomenon (temporary transit through cardia when hydrostatic pressure of barium column is above toxic LES pressure).Vigorous achalasia (numerous tertiary contractions in nondilated distal esophagus of early achalasia)ECandidial esophagitis'Cobble stone' mucosa.Shaggy/fuzzy contour of the esophagusFCytomegalovirus esophagitis.Giant ovoid flat ulcers.GHerpes esophagitisDiscrete superficial punctate/ linear serpentine/ stellate/ diamond shaped ulcersHHiatus herniaEpiphrenic bulge.Four longitudinal coarse thick gastric folds above gastroesophageal junction or in the suprahiatal pouch.Distance between B ring & hiatal margin > 2 cm.Peristalsis causes above hiatus.JSclerodermaLower third esophagus mostly affected.Esophageal shortening.Sliding hiatus hernia.'Hidebound' esophagus.KCarcinoma oesophagus'Rat-tail' esophagus.Shouldering sign.LCorrosive poisoning (Lye stricture)TightLongSmooth stricture