question: Q:A 55-year-old man comes to the physician because of heartburn for the past 2 years. He has no chest pain, dysphagia, weight loss, or fever. He has no history of any serious illnesses. He takes omeprazole daily. Vital signs are within normal limits. Body mass index (BMI) is 34 kg/m2. Physical exam shows no abnormalities. An endoscopic image of the lower esophageal sphincter is shown. Which of the following is the most important next step in management?? 
  {'A': 'Endoscopic mucosal ablation therapy', 'B': 'Esophagectomy', 'C': 'High-dose pantoprazole', 'D': 'Laparoscopic Nissen fundoplication', 'E': 'Multiple endoscopic biopsies'},