A dory nutter +1 029278 a significant case of normative determinism 91 year old lady referred early december with dysphasia a background of hypertension asthma breast cancer lung cancer type 2 diabetes chronic normocytic anemia and hypothyroidism so 1 and a half years of weight loss of 1 and a half stone eats weetabix with honey twice per day and occasionally chocolate but nothing else early satiety decreased appetite and significant volume reflux for at least the last 2 years referred for upper gi endoscopy in 2023 came for a nasal endoscopy with a physician's assistant and attempted transnasal approach but abandoned due to nose pain and didn't rebook any further endoscopies note that she had a normal upper endoscopy in 2019 then she went on to have a ct: which identified a sigmoid polyp which was then excised she describes a constellation of symptoms where in the morning she her stomach will feel so full she can't get anything in her mouth is full of gunk and gunge which she says comes up and then she has to cough and splutter after it's reflux effortlessly into the back of her throat gaviscon calms things down somewhat and she does take lansoprazole but doesn't improve things significantly now I suspect this is esophageal dysmotility maybe achalasia and I think investigating with an upper gi endoscopy in the first instance would be prudent if that's normal then giving her lifestyle management considering barium could be the next step