Oesophageal Disorders

The answer first

Almost everything an examiner can ask about the oesophagus hangs off one history question: what does the patient struggle to swallow, and how has it evolved? Dysphagia that begins with solids and progresses is a mechanical narrowing (stricture, ring, cancer) until proven otherwise; dysphagia that involves liquids from the very first day is a motility disorder (achalasia, spasm) until proven otherwise. Get that distinction out loud in the first thirty seconds and the rest of the work-up — endoscopy, barium swallow, manometry — falls into place behind it ^[1].

Three further rules carry the DWE and the long case ^[2]:

1. Alarm features change the first test. Progressive dysphagia, weight loss, anaemia, haematemesis or persistent vomiting means endoscopy now — not a PPI trial and a review in eight weeks ^[1].
2. Prove the disease before you escalate the treatment. Refractory "reflux" deserves objective pH-impedance testing off PPI before anyone reaches for a fundoplication; suspected achalasia deserves manometry before anyone dilates anything ^{[2] [19]}.
3. Dysplasia ends surveillance. A Barrett's patient with confirmed dysplasia has crossed from watching to treating — endoscopic eradication with resection of visible lesions plus radiofrequency ablation is the standard, backed by randomised trials ^{[5] [8] [9]}.

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References25ShowHide

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