A 54-Year-Old Obese Male Comes into the Clinic Complaining of Intermittent

A 54-year-old obese male comes into the clinic complaining of intermittent substernal chest pain and increased symptoms of indigestion and reflux. He says he has the pain frequently after eating a fatty meal. He has a history of hypertension and a family history of coronary artery disease. What would you do first?

A) Treat with a proton pump inhibitor.
B) Refer to a gastroenterologist for an endoscopy.
C) Obtain a cardiac evaluation.
D) Order esophageal motility studies/swallowing study to look for esophageal spasm.
E) Counsel about a low-fat, antireflux diet.