A case of dysphagia post-surgery

A 71-year-old male patient presented to the outpatient clinic with ongoing dysphagia, intermittent bouts of severe epigastric pain and weight loss. He had undergone hiatal hernia repair four years prior due to similar complaints, but this did not alter his symptoms. Postoperative evaluation with gastroscopy, esophageal manometry and esophageal X-ray was suggestive of distal esophageal spasms, for which nitroglycerine and calcium channel blockers were tried, without effect. Four years after surgery, he reports worsening dysphagia for solid but not for liquid meals, with a recent weight loss of 5kg over a few months. Repeat endoscopy and abdominal CT scan were unremarkable except for the postoperative state, esophageal X-ray showed reduced primary peristalsis with tertiary contractions and limited stasis of contrast in a slightly dilated distal esophagus.