A 62-Year-Old Man Comes to the Office Due to Difficulty

A 62-year-old man comes to the office due to difficulty swallowing both solids and liquids.  The patient's symptoms have progressively worsened over the last 3 months.  He also has occasional regurgitation of undigested food and a nighttime cough that disturbs his sleep.  He has never had similar symptoms before.  The patient has lost 4.5 kg (10 lb) during this period but has no other medical problems and takes no medications.  He has a 20-pack-year smoking history but quit 10 years ago.  He drinks wine on the weekends.  Vital signs are normal, and his physical examination is unremarkable.  Chest x-ray reveals a widened mediastinum, and barium studies show a dilated esophagus with smooth tapering of the distal esophagus.  Which of the following is the best next step in management of this patient?

A) CT scan of the chest
B) Endoscopic evaluation
C) Esophageal pH monitoring
D) Laparoscopic myotomy
E) Reassurance and calcium channel blocker
F) Trial of proton pump inhibitor

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free