A 44-year-old man comes in with reports of heartburn, substernal pain, regurgitation, and difficulty swallowing. He likes to eat foods that have "substance," like hamburgers, steaks, fries, rich desserts, etc. He says his wife is a great cook and prepares all his favorite dishes with extra butter. He has had heartburn for years. To relieve the heartburn, he has taken antacids. This time, the pain is worse. He has eaten a large fatty meal within the last hour. He denies other medical problems. He does not smoke and only occasionally uses alcohol. On physical exam, he weighs 280 lb and is 5'10".What is the most likely diagnosis?

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