A sprightly 82 year old woman with a past history of a small hiatus hernia is recently diagnosed with osteoporosis and started on appropriate treatment. Three months later she complains to her family physician during a routine visit of progressive dysphagia to solids, especially to meat. The family physician notes that she has lost 3 kg in weight although she retains a good appetite. She has no other symptoms and clinical examination is otherwise unremarkable. What is the most likely explanation?

Elderly patients generally/have a higher prevalence of oesophageal motility disorders that affect swallowing. In this case, she is very likely to have been starte.d on bisphosphonates for her osteoporosis. Bisphosphonates cause oesophageal ulceration and should be used with caution in patients with known oesophageal disorders. Patients should be clearly instructed to always take their dose with a full glass of water on an empty stomach, and to stand or sit upright for at least 30 minutes after taking the dose. Eosinophilic oesophagitis is much more common in children. This patient is less likely to have a cancer as she retains her appetite and general well-being. The Plummer-Vinson syndrome is a rare disease characterised by dysphagia, iron deficiency anaemia, angular stomatitis, atrophic glossitis, cheilosis and oesophageal webs. She had none of these features on clinical examination.