TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. TS denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. TS describes the dysphagia this way: "Food gets stuck in my throat, and I can’t get it down." The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper GI endoscopy. Required:

a. What is the likely cause of the dysphagia?
b. What advice should he be given regarding his OTC medication at this time?
c. What are the usual signs and symptoms of GERD? How will it be managed?

Dyspahgia and alcohol are related.Past years of alcohol(besides medication for asthma,sedatives,antidepressants) intake may  trigger  the transformation of some of the cells lining the oesophagus. The oesophagus  is  lined with stratified epithelial  cells. Persistent alcohol intake may lead to  transformation these cells to abnormal cell of  columnar epithelial.They are known as Dysplasia

The dysplasia  in the patients  leads to Barrett's esophagus.These Columnar cells makes the oesophagus of TS prone to  esophageal adenocarcinoma .The dysplasia  may lead to tumour,and therefore  obstruction of the oesophagus.This may therefore account for  the Dysphagia experienced by TS,Hence peristalsis is inhibited and soild foods can  not be moved down,

2.The state of the medication should be liquid. Because of  the difficulty in swallowing,which  will not allow the medication to reach stomach,for absorption.Intravenous administration can also be adopted.

3. Dysphagia,burning sensation due to acid reflex , pain in the chest and upper abdominal part ,tendencies to regurgitate foods,bad breath, are some of the symptoms of Gastroestro esophageal reflux,

Abstinence from alcohol,oily foods,smoking,avoiding lying down immediately after eating,avoidance of carbonated drinks,tight clothing at the waist, and use of  herbal products e.g marshmallow are examples of method of managements

Use of anti acids,H2 blockers,and application of erythromycin,together with surgery are used for the managements.

Explanation: