Which study is obtained first to evaluate progressive dysphagia before definitive diagnosis?

• A. Barium esophagogram
• B. Endoscopy with biopsy
• C. CT scan
• D. MRI

Answer: (A)

When progressive dysphagia is suspected, start with a test that noninvasively outlines the esophagus and shows how the lumen and peristalsis are functioning. A barium esophagram achieves this by having the patient swallow contrast and watching real-time fluoroscopic images of the esophagus. It can pinpoint where a narrowing is, its length, and whether it looks like a benign structure (rings, webs), a mass causing a fixed obstruction, external compression, or a motility problem. This information helps guide the next steps, typically endoscopy with biopsy for a definitive tissue diagnosis and treatment planning. Imaging like CT or MRI is more useful for staging or evaluating invasion once a malignancy is suspected, rather than serving as the initial assessment for dysphagia.