Question

An elderly male patient presents with progressive dysphagia, particularly for solids, along with marked loss of weight. What is the most likely diagnosis?

• A. Achalasia cardia
• B. Carcinoma of oesophagus
• C. Reflux oesophagitis
• D. Stricture oesophagus

Hint:

Focus on how the dysphagia progressed — solids first — and what that pattern usually points to in an older patient.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The question describes an elderly man with dysphagia that has progressed over time, affects solids more than liquids, and is accompanied by significant weight loss, and asks for the most likely diagnosis.

Step 2: Key Concept or Approach:
The pattern of dysphagia is a key clue. Mechanical, structural narrowing of the oesophagus tends to first block solids and only later affects liquids as the lumen narrows further, while a motility disorder tends to affect solids and liquids together from the start. Rapid, marked weight loss out of proportion to the degree of dysphagia points toward a malignant cause rather than a benign one.

Step 3: Working Through the Options:
Achalasia cardia is a motor disorder of the lower oesophageal sphincter, so dysphagia for both solids and liquids appears together from early on, often with regurgitation of undigested food, and it is more common in younger and middle-aged adults; the weight loss is usually gradual rather than marked. Reflux oesophagitis usually presents with heartburn and retrosternal burning rather than progressive mechanical dysphagia, and severe weight loss is not typical unless a stricture has already formed. A benign stricture oesophagus usually follows long-standing reflux or a caustic injury, and while it does cause dysphagia for solids, the marked, rapid weight loss described here is more in keeping with malignancy. Carcinoma of the oesophagus classically presents in an elderly patient with progressive dysphagia that starts with solids and later extends to liquids as the tumour narrows the lumen, together with striking weight loss from reduced intake and the catabolic effect of the tumour itself.

Step 4: Conclusion:
The most likely diagnosis is carcinoma of the oesophagus.