A 29-year-old woman complains of dysphagia with both solids and liquids, worse when she is eating quickly or is anxious. Manometry reveals normal basal esophageal sphincter pressure, with no relaxation of the sphincter on swallowing. Which of the following is the most appropriate next step in management?
calcium channel blockers
These findings are characteristic of achalasia. Anticholinergic medications and dietary changes do not provide much help. Successful therapies include nitroglycerine, nifedipine (a calcium channel blocker), botulinum toxin injected endoscopically, balloon dilatation, and esophageal myotomy (not excision).