A 28-YEAR-OLD, previously healthy man visited a gastroenterologist with symptoms that included regurgitation of foods and liquids when in the supine position or while bending over. He also had paroxysms of coughing and an unintentional weight loss of 20 lbs (9.1 kg). These symptoms developed during a 6-month period and did not respond to dietary modifications, sleeping with the head of the bed elevated, or treatmentwith proton-pump inhibitors. The patient denied frank heartburn, dysphagia, chest pain, nausea, and loss of appetite. He had no history of tobacco or alcohol use. Results of his physical examination were normal. A radiograph image was obtained (Figure 1).