Answer and Explanation 10

10.  The correct answer is D.  Patients with scleroderma frequently have esophageal motility disorders such as Achlasia.  These patients need aggressive treatment of their GERD with proton pump inhibitors.  The pathogenesis of achlasia involves loss of ganglion cells in Auerbach’s plexus leads to increased tone and impaired relaxation of the lower esophageal sphincter.  Treatment may involve dilation, treatment with nitroglycerin, treatment with calcium channel blockers, or treatment with anticholinergic agents that all help in relaxing the lower esophageal sphincter.