<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 45-year-old woman comes to the physician because of progressive difficulty swallowing solids and liquids over the past 4 months. She has lost 4 kg 9 lb during this period. There is no history of serious illness. She emigrated to the US from Panama 7 years ago. She does not smoke cigarettes or drink alcohol. Cardiopulmonary examination shows a systolic murmur and an S3 gallop. A barium radiograph of the chest is shown. Endoscopic biopsy of the distal esophagus is most likely to show which of the following?? A: Atrophy of esophageal smooth muscle cells, B: Presence of intranuclear basophilic inclusions, C: Infiltration of eosinophils in the epithelium, D: Absence of myenteric plexus neurons, E: Presence of metaplastic columnar epithelium,  <response>: This is a clinical vignette describing a 45-year-old woman with progressive dysphagia to solids and liquids over 4 months associated with weight loss. She recently immigrated from Panama. Physical exam shows a murmur and gallop suggesting possible heart disease. Imaging shows a dilated esophagus concerning for an obstructive process. Biopsy of the distal esophagus is being considered to help establish the diagnosis. The key finding is that she immigrated from Panama, which makes Chagas disease a important diagnostic consideration given it is endemic there. Chagas disease can cause destruction of the myenteric plexus neurons in the esophagus leading to dysmotility and megaesophagus.Therefore, the absence of myenteric plexus neurons on biopsy would be most consistent with Chagas disease as the underlying cause.D: Absence of myenteric plexus neurons 