A patient presents to a physician because of troubling "heaburn" and difficulty swallowing. Esophageal motility studies demonstrate a near absence of smooth muscle peristalsis and lower oesophageal sphincter tone. No mass lesions are noted and the esophagus is not dilated. Which of the following findings would most likely also be present?

Near complete absence of muscle tone and peristalsis is characteristic of involvement of the esophagus with scleroderma, which causes replacement of muscle by dense connective tissue. Similar changes in the dermis cause the skin to be thickened. The thickened, shiny skin of the hands may cause them to resemble claws. Anemia and atrophic glossitis are associated with esophageal webs in Plummer-Vinson syndrome. An hourglass-shaped stomach within the thoracic cavity is a feature of a sliding hiatal hernia. Ref: Moinzadeh P., Denton C.P., Krieg T., Black C.M. (2012). Chapter 157. Scleroderma. In K. Wolff (Ed), Fitzpatrick's Dermatology in General Medicine, 8e.