Clinical presentation

A 50-year-old woman presented with a 4-month history of progressive dysphagia and associated weight loss. Her medical history was unremarkable, and she was not taking any medication. Gastroscopy revealed a tight impassable stricture at 30 cm (figure 1A) confirmed on barium swallow (figure 1B). Biopsies from the stricture were reported as consistent with reflux oesophagitis with no evidence of malignancy. The stricture was dilated revealing a short segment of normal distal oesophagus above a small hiatus hernia. She was started on a high-dose proton pump inhibitor. She re-presented 3 months later with recurrent dysphagia and again had …