Which differential for regurgitation involves autonomic dysfunction as a neuromuscular factor?

• A. Lead
• B. Hypothyroidism
• C. Hypoadrenocorticism
• D. Dysautonomia

Answer: (D)

Regurgitation from an esophageal motor problem points to a neuromuscular control issue, and the autonomic nervous system is the key regulator of GI smooth muscle tone and peristalsis. When autonomic function is impaired (dysautonomia), the esophagus loses coordinated motility and the lower esophageal sphincter–esophageal body coordination fails, so food backs up and exits passively as regurgitation rather than being forcefully expelled as vomiting. This makes autonomic dysfunction the best match for a differential that centers on autonomic neuromuscular failure. Other options involve toxins or hormonal effects that can alter neuromuscular function in other ways but do not specifically imply autonomic motor failure of the esophagus.