How would you approach the treatment of a patient with solid food esophageal dysphagia and GERD without a detectable esophageal stricture on upper endoscopy?

I would obtain a barium esophagram followed by high-resolution esophageal manometry and 48-hour esophageal pH testing.

In the absence of erosive change and stricture, GERD with spasm and eosinophilic esophagitis are the next possible diagnoses. Consider other causes of spasm if treatment of these possibilities is not successful.

Esophogram

Check biopsies for EoE prox/distal if neg Ba study with pill/marshmallow, then if neg HRM/FLIP while treating for GERD with Pcab