Clinical Presentation

A 68-year-old woman has gastroesophageal reflux and midepigastric pain.

(A) Frontal chest radiograph shows bilateral basilar interstitial lung disease (arrows). (B) Upright barium esophagogram shows a widely patent gastroesophageal junction (arrow). (C) A focal segment of the dorsum of the esophagus shows mucosal irregularity (arrows), possibly representing esophagitis.

Differential Diagnosis

• Scleroderma: This is the most likely diagnosis, given the patulous esophagus and the bilateral basilar interstitial lung disease.

• Rheumatoid arthritis: This is a possibility as it can result in an atonic esophagus and interstitial lung disease.