A 62-year old man presents to your clinic complaining of progressive difficulty swallowing for the past 3 months. He says it feels like the food gets caught up in his throat (pointing to his chest.) He says it’s to solids only, and that he hasn’t noticed any trouble with fluids. He is otherwise healthy. He denies symptoms of reflux or regurgitation and denies heartburn. He has a 60 pack-year smoking history and used to drink a beer or two daily until age 50. Lung sounds are lear to auscultation, heart rate and rhythm are regular; abdomen is soft, nontender, non-distended. Bowel sound are normal. Rectal exam is negative for masses, but positive for stool guaiac. Which of the following is the best next step in the management of this pt?
- A) Upper endoscopy (EGD)
- B) Barium esophagram
- C) esophageal manometry
- D) MRI
- E) Endoscopic ultrasound
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