Question

TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. TS denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. TS describes the dysphagia this way: “Food gets stuck in my throat, and I can’t get it down.” The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper gastrointestinal endoscopy.

1. What is the likely cause of his dysphagia?

Answer 1

Ts was an alcoholic in the past and Heavy alcohol consumption can lead to dysplasia of the columnar epithelial tissues in the oesophagus and the squamous epithelial tissue. This condition is called Barret’s esophagus. Barrett’s esophagus generally puts the patient  at a greater risk of developing cancerous tumors. A tumor in the esophagus would cause an obstruction that is difficult for solids to pass. That's is the reason why he's having problems swallowing.