WEEK 1
DYSPHAGIA
A 45-year-old man presented to his doctor with a swallowing problem. Although he neither smokes nor drinks alcohol he has chewed tobacco for the past twenty years. His general health has always been good and weight steady. He has good appetite and regular bowel habit, which he has attributed to the brisk fifteen minute walk he takes every day to and from work.
Six months ago he noticed that he had difficulty in swallowing mouthfuls of a fried mutton dish. The food seemed stuck behind an area in his lower chest; thereafter this occurred when he ate solid food, at first intermittently and then every time. The level of the “blockage” seemed constant. There was nothing more than a discomfort associated with this problem but occasionally he had to retire while eating and vomit “what had stuck” down the toilet.
Over the last month he had noticed increased saliva in his mouth and also spontaneous regurgitation of food and an irritating cough in the morning. At the same time he had modified his diet and drank mostly soups and fluids.
When he met his GP he had already lost 10 kilograms in weight from a steady 75 kilograms previously. His GP had referred him to a specialist as a matter of urgency.
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