What is the first step in the workup for a patient presenting with dysphagia?

• A. Upper endoscopy
• B. Barium swallow
• C. CT scan of the neck
• D. Esophageal manometry

Answer: (B)

In evaluating a patient presenting with dysphagia, the first step typically involves a barium swallow study. This imaging technique allows for the visualization of the esophagus as the patient swallows a contrast medium (barium), helping to identify any structural abnormalities, such as strictures, tumors, or motility disorders. It provides crucial preliminary information regarding the swallowing mechanism, as well as insight into any possible obstructions or anatomical defects.

Following a barium swallow, further tests like upper endoscopy might be performed if there are indications of more complex issues, but the barium swallow is generally favored initially because it is less invasive and can quickly provide essential information about the anatomy and function of the esophagus. Other modalities, such as CT scans or esophageal manometry, may be used later in the workup to provide more detailed information as needed based on the initial findings.