<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 37-year-old woman comes to the physician because of difficulty swallowing for the past 1 year. She was diagnosed with gastroesophageal reflux 3 years ago and takes pantoprazole. She has smoked a pack of cigarettes daily for 14 years. Examination shows hardening of the skin of the fingers and several white papules on the fingertips. There are small dilated blood vessels on the face. Which of the following is the most likely cause of this patients difficulty swallowing?? A: Esophageal smooth muscle fibrosis, B: Degeneration of neurons within esophageal wall, C: Outpouching of the lower pharyngeal mucosa, D: Demyelination of brain and spinal cord axons, E: Tissue membrane obstructing esophageal lumen,  <response>: This is a clinical vignette describing a 37-year-old woman with a 1 year history of dysphagia difficulty swallowing. She has a history of gastroesophageal reflux disease GERD and chronic tobacco use. Her physical exam is significant for skin changes suggestive of scleroderma hardening of the skin, white papules on fingertips as well as telangiectasias dilated blood vessels on her face. The key finding is the presence of scleroderma, which is associated with esophageal involvement. Scleroderma can cause fibrosis and dysfunction of the esophageal smooth muscle, leading to dysphagia.Choice A Esophageal smooth muscle fibrosis is the most likely cause of her dysphagia given her history and physical exam findings. Choices B, C, D, and E are not associated with scleroderma.A: Esophageal smooth muscle fibrosis 