Card 2 / 34: A 54 year-old man complains of frequent heartburn. He reports a burning sensation in his chest within an hour of eating a large meal. He notes a similar sensation when he is in a supine position, particularly at bedtime. He denies any dysphagia or odynophagia. Which of the following is the most likely mechanism resulting in the patient’s symptoms?
1.) Absent peristalsis in the esophageal body
2.) Transient relaxations of the LES (lower esophageal sphincter) without peristalsis
3.) Multiple, simultaneous peristaltic contractions
4.) High amplitude peristaltic contractions in the esophageal body
5.) High LES pressure with failure of the LES to relax with swallowing

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