A 56-Year-Old Man Comes to the Physician Due to Several

A 56-year-old man comes to the physician due to several months of difficulty in swallowing.  At first, meat would stick in his throat, and now he has difficulty swallowing all solid food and occasionally liquids.  The patient coughs and sometimes aspirates food particles when eating.  He has no shortness of breath, chest pain, or heartburn and has lost several pounds in the last 2 months.  The patient was evaluated for persistent right ear pain 4 weeks ago, but no diagnosis could be made.  His past medical history is significant for hypertension.  He smokes 2 packs of cigarettes daily and consumes 6-8 bottles of beer on weekends.  The patient is not sexually active.  Lungs are clear to auscultation.  Neck palpation shows no lymph node enlargement or thyromegaly.  Which of the following is the best initial step in management of this patient?

A) CT chest scan
B) Esophageal manometry
C) Esophagogastroduodenoscopy
D) Nasopharyngeal laryngoscopy
E) Videofluoroscopic barium swallow

Correct Answer:

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