18th July 2023

A 72-year-old man presents with a 4-month history of feeling like food is sticking when he swallows

A 72-year-old man presents with a 4-month history of feeling like food is sticking when he swallows. He also notes difficulties with liquids and experiences retrosternal chest pain after drinking large volumes of fluid and sometimes regurgitates after meals. In the last 4 months he has lost 4kg in weight.

He has a past medical history of coeliac disease and long-standing GORD, which had been well controlled with lansoprazole 30mg OD. He had an OGD 14 months ago to investigate his reflux, which was normal. His GP refers him for a barium swallow assessment, which reveals a bird’s beak appearance at the distal oesophagus. Manometry shows increased pressure at the lower oesophageal sphincter.

What is the next best step in management?

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