A 74-Year-Old Man Comes to the Office Due to Difficulty

A 74-year-old man comes to the office due to difficulty swallowing food.  The symptoms began 4 months ago when the patient was eating steak and felt like a bite got stuck in the middle of his chest, which resolved after drinking a glass of water.  Since then, he has had several similar episodes when eating bread or meat and has modified his diet to soft foods.  He has no difficulty drinking liquids and has had no chest or abdominal pain, vomiting, melena, or weight loss.  The patient has occasional nighttime heartburn, especially after eating spicy food, and takes antacids as needed.  His other medical conditions include hypertension, for which he takes lisinopril.  He does not use tobacco, alcohol, or illicit drugs.  Family history is unremarkable.  Vital signs are within normal limits.  Physical examination shows normal dentition and oropharyngeal mucosa.  Tonsils are normal.  The lungs are clear on auscultation, and heart sounds are normal.  The abdomen is soft and nontender with no organomegaly.  The remainder of the physical examination shows no abnormalities. Which of the following is the best next step in management of this patient?

A) 6-week trial of a proton pump inhibitor
B) CT scan of the chest
C) Esophageal manometry
D) Test for Helicobacter pylori infection
E) Upper gastrointestinal endoscopy

Correct Answer:

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