Question: A 64-year-old man with systemic lupus erythematosus was referred for evaluation of dysphagia and regurgitation. The patient reported a 10-year history of difficulty swallowing solid foods with associated burning substernal chest discomfort. He was not symptomatic with drinking, but his symptoms progressed, and he developed occasional regurgitation. He was treated empirically for gastroesophageal reflux disease with esomeprazole 20 mg/d; however, he noted persistent symptoms. He did not report weight loss, neurologic deficits, or prior stroke.