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A 45-year-old male presents to your clinic with complaints of heartburn and progressive difficulty swallowing both liquids and solids over the past two years. He has been taking an over-the-counter proton pump inhibitor for the past 6 months without resolution of his symptoms. He is otherwise healthy and has no personal or family history of cancer. He is a nonsmoker. You order a barium swallow study, the results of which are shown in Figure A. What would you expect to see on manometry in this patient?
Normal esophageal motility with normal relaxation of the lower esophageal sphincter
Normal esophageal motility with increased tone of the lower esophageal sphincter
Absent peristalsis in the distal esophagus and decreased resting tone of the lower esophageal sphincter
Simultaneous esophageal contractions
Absent peristalsis in the distal esophagus and increased resting tone of the lower esophageal sphincter
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A 37-year-old man presents to his primary care provider with dysphagia. He notes that his symptoms began several weeks ago and have worsened over time. He now has trouble swallowing solids and liquids. He denies any other symptoms. He has no significant past medical history. Travel history reveals a recent trip to South America but no other travel outside the United States. His temperature is 100°F (37.8°C), blood pressure is 120/81 mmHg, pulse is 99/min, respirations are 14/min, and oxygen saturation is 98% on room air. HEENT exam is unremarkable. He has no palpable masses in his abdomen. What is the most appropriate next step in management?