Oesophageal Disorders — DCE Clinical Case

Focused history — what you must establish

• The discriminating dysphagia history: solids first or liquids from the start; progressive or intermittent; localisation; regurgitation character (acidic versus bland undigested food); odynophagia as a separate symptom; and the tempo over weeks to months ^[1].
• Alarm inventory: weight loss and its amount, appetite, haematemesis or melaena, anaemia symptoms, voice change, persistent cough or aspiration episodes ^[1].
• Risk profile: smoking and alcohol (squamous risk), reflux duration and severity with central obesity (adenocarcinoma risk via Barrett's), prior caustic ingestion, achalasia history, and any prior endoscopy ^[2].
• The host for what may come: cardiorespiratory comorbidity, performance status and nutrition — the variables that decide whether neoadjuvant therapy and oesophagectomy are even on the table ^[3].
• The patient's frame: what he thinks is happening, what he fears, and who supports him — a five-month delay in presentation usually has a reason.