رجل عمره ٦٦ سنة مدخن ويشرب الكحول، عنده صعوبة بلع تزيد تدريجياً منذ ٣ أشهر، بدأت بالأكل الصلب والآن حتى اللين، ونقص وزنه ٩ كغ. لا يوجد ألم صدر، والعلامات الحيوية طبيعية. ما الإجراء الأنسب؟

A 66-year-old man who smokes and drinks alcohol has had progressive dysphagia for 3 months, starting with solids and now with soft food, and has lost 9 kg. No chest pain and normal vitals. What is the most appropriate action?

1. Eat more solid food to stretch the oesophagus
2. Urgent upper endoscopy to exclude oesophageal cancer
3. A 3-month trial of antacids first
4. Reassure him it is a stress-related problem

Answer: B) Urgent upper endoscopy to exclude oesophageal cancer. Progressive dysphagia from solids to liquids with weight loss in a smoker who drinks is a red flag for oesophageal cancer requiring urgent endoscopy.