This 32 year old man has been suffering from esophageal achalasia for about 10 years, which he has managed by meticulously cutting and chewing all his food. At that time they offered him a surgery, in a public hospital, but he declined it. At endoscopy, copious amounts of food and liquid were seen in the obviously dilated esophagus. The incidence of achalasia is approximately 1 per 100,000 people per year. Chagas disease may cause a similar disorder due to Trypanosoma Cruzi.
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