Regurgitation of undigested food is most characteristic of which condition?

• A. Achalasia with non-relaxing LES.
• B. GERD with acid regurgitation.
• C. Scleroderma-related reflux.
• D. Candidal esophagitis.

Answer: (A)

Regurgitation of undigested food happens when the esophagus cannot clear its contents into the stomach. In achalasia, the esophageal body loses peristalsis and the lower esophageal sphincter fails to relax, creating a functional obstruction at the junction. Food that is swallowed accumulates in the esophagus and is later expelled as undigested material, often while lying down at night. This classic pattern distinguishes it from other causes of reflux.

GERD commonly causes regurgitation of stomach acid rather than undigested food. Scleroderma-related reflux involves reflux due to decreased LES tone and esophageal hypomotility, but regurgitation of undigested food isn’t characteristic. Candidal esophagitis presents with pain on swallowing and swallowing difficulties, not primarily regurgitation of undigested food.