Physician's Assistant

Patient Details

Refined clinic supervision (15 weeks ago 14:59)

Refined clinic supervision Mon 22 December 2025 14:59

Last Modified: 15 weeks ago

MRN:

Content:

Unknown, 91, 1029278.
New referral
Main issue was dysphagia with significant weight loss and reflux symptoms.

This 91-year-old lady was referred in early December with dysphagia. She has a background of hypertension, asthma, breast cancer, lung cancer, type 2 diabetes, chronic normocytic anaemia and hypothyroidism. Over the past 1.5 years she has lost 1.5 stone in weight. Her current intake is extremely limited - she eats Weetabix with honey twice per day and occasionally chocolate but nothing else. She reports early satiety, decreased appetite and significant volume reflux for at least the last 2 years.

She was referred for upper GI endoscopy in 2023 and came for nasal endoscopy with a physician's assistant. A transnasal approach was attempted but abandoned due to nose pain and she didn't rebook any further endoscopies. Of note, she had a normal upper endoscopy in 2019. She subsequently had a CT scan which identified a sigmoid polyp which was then excised.

She describes a constellation of symptoms where in the morning her stomach feels so full she can't get anything in her mouth. Her mouth fills with gunk and gunge which comes up, then she has to cough and splutter after reflux effortlessly reaches the back of her throat. Gaviscon calms things down somewhat and she takes lansoprazole but this doesn't improve things significantly.

I suspect this is oesophageal dysmotility, possibly achalasia, given the constellation of symptoms including dysphagia, significant reflux, early satiety and progressive weight loss.

Plan was upper GI endoscopy in the first instance. If normal, lifestyle management and consideration of barium swallow would be the next step.

Point to discuss in supervision: Management approach for suspected achalasia in elderly frail patient with multiple comorbidities.

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Refined clinic supervision (104 days ago 09:27)

Refined clinic supervision Tue 23 December 2025 09:27

Last Modified: 104 days ago

MRN:

Content:

Doreen Nutter, 91 years old, 1029278

Dysphagia referred early December - triaged by MF to any urgent clinic incl IDA.

• Background: hypertension, asthma, breast cancer, lung cancer (both treated curatively), type 2 diabetes, chronic normocytic anaemia, hypothyroidism
• 18-month Hx of weight loss (1.5 stone)
• Severe dietary restriction: only eats Weetabix with honey twice daily, occasionally chocolate
• Early satiety and decreased appetite
• Significant volume reflux for 2+ years
• Morning symptoms: stomach feels full, mouth full of 'gunk and gunge' which refluxes effortlessly into throat
• Coughing and spluttering episodes
• Gaviscon provides some relief, Lansoprazole ineffective
• Previous normal upper endoscopy 2019
• Attempted transnasal endoscopy 2023 - abandoned due to nose pain, never rebooked
• CT for anaemia in 2019 identified sigmoid polyp which was subsequently excised
• Clinical suspicion: oesophageal dysmotility, possibly achalasia

Plan was
• Upper GI endoscopy in first instance
• If normal endoscopy, consider lifestyle management and barium swallow
• Address significant nutritional concerns given restricted intake

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