For Persistent Dysphagia, What Test Next?

The patient specifically reports difficulty swallowing at the level of the sternal notch. An upper endoscopy 10 years ago found no abnormality. Which of these tests makes sense now?

A 55-year-old man complains of dysphagia that he has experienced for several years. Upon further questioning, he specifically reports difficulty swallowing at the level of the sternal notch, along with occasional regurgitation of food particles. He had an upper endoscopy 10 years earlier for similar symptoms, however he reports the findings were normal.

 

Which of the following studies should be performed next?

A. Repeat upper endoscopy with esophageal biopsies
B. Barium swallow
C. Esophageal manometry
D. CT of the chest and abdomen
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