A 35-year-old woman with intact oropharyngeal swallow but complaints of esophageal symptoms; appropriate plan is to:

• A. Refer her for evaluation of esophageal functioning
• B. Refer her to pulmonologists
• C. Have the patient begin lingual exercises to increase intrabolus pressure
• D. Modify diet viscosity

Answer: (A)

When oropharyngeal swallowing is functioning normally but the patient reports esophageal-type symptoms, the problem is likely esophageal in origin. The best next step is to pursue esophageal-function testing to identify the underlying issue—motility disorders, strictures, rings, diverticula, or reflux-related disease. This typically means referring to a gastroenterologist for tests such as esophageal manometry and endoscopy, with a barium swallow considered if needed. Only after confirming the esophageal cause would treatment be guided by the specific diagnosis.

Other options miss the focus on the esophagus. Pulmonology isn’t indicated by the presentation, lingual exercises target the oropharyngeal phase, and while adjusting diet viscosity can help some symptoms, it doesn’t establish the diagnosis or address the underlying esophageal problem.