First AD

Second AD

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.

A. Repeat upper endoscopy with esophageal biopsies 

This patient’s symptoms are suggestive of a Zenker’s diverticulum. This is an outpouching that herniates through Killian’s triangle, which is formed between the oblique fibers of the inferior constrictor muscle of the pharynx and the transverse fibers of the cricopharyngeus muscle. It causes difficulty swallowing and leads to regurgitation of food particles, often days after consuming a meal.

Gastrointestinal Disorders

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?

For Persistent Dysphagia, What Test Next?