A 60 yrs old pt presenting with dysphagia of 6 wks duration with solid foods. Now can swallow only liquids. Investigations done to diagnose here ?
**Core Concept**
The question is testing the ability to diagnose the cause of dysphagia in an elderly patient. Dysphagia is a symptom of various conditions affecting the esophagus, including mechanical obstruction, motility disorders, and esophageal cancer. A thorough evaluation is necessary to determine the underlying cause.
**Why the Correct Answer is Right**
A thorough evaluation of dysphagia involves a combination of clinical assessment, imaging studies, and endoscopic examinations. In this patient, the 6-week duration of symptoms and progressive worsening of dysphagia suggest a mechanical obstruction. The investigation of choice would be an **esophageal barium swallow (EGD) or a computed tomography (CT) scan of the chest**. These studies can help identify the level and cause of the obstruction, whether it be a tumor, stricture, or other lesion.
**Why Each Wrong Option is Incorrect**
* **Option A:** **Upper GI endoscopy** might be useful in evaluating the esophagus, but it is not the first-line investigation for a mechanical obstruction.
* **Option B:** **Manometry** is useful in diagnosing motility disorders, but it is not the initial investigation for a patient with progressive dysphagia to solids.
* **Option C:** **Gastroscopy** can be useful in evaluating the stomach and duodenum, but it is not the most appropriate initial investigation for a patient with dysphagia to solids.
**Clinical Pearl / High-Yield Fact**
In patients with dysphagia, a thorough evaluation is necessary to determine the underlying cause. A high index of suspicion for esophageal cancer is essential in elderly patients with progressive dysphagia to solids.
**Correct Answer: D. A computed tomography (CT) scan of the chest.**