Causes related to the level of the disease. Causes related to location of disease. Lower third Carcinoma, Peptic strictures, Caustic strictures, Achalasia 3. The history of the patient forms an important part of the workup. Particularly difficult to elicit is the situation of foreign body ingestion in children.
Adults generally localise the level of the food sticking in the food pipe quite accurately.
However some patients with lower third lesions point to the upper oesophagus as the level of obstruction. A long preceding history of heartburn denotes a peptic aetiology. History of weight loss may denote a neoplasm as does dysphagia for solids. Difficulty with fluids more than solids indicates a motility disorder 2 . A neurological history indicates a disturbance of the swallowing mechanism.