Dysphagia is a symptom that needs prompt and thorough investigation. Difficulties arise when presentations are atypical, but limitations of the diagnostic tests and lack of awareness of medication-related oesophageal damage can also create problems.
- Dysphagia and pain on swallowing require prompt investigation.
- Up to 20% of patients with peptic stricture may be unaware of acid reflux symptoms.
- Both radiology and endoscopy may miss a minimal stricture or motility disorders. Oesophageal manometry is essential if a diagnosis is not made after good quality radiology and endoscopy.
- Minimal strictures and webs may be overlooked if the swallowing of a solid bolus is not assessed in the radiology study.
- Several frequently used medications can cause or aggravate oesophageal ulceration, especially if passage through the oesophagus is delayed.