Your next patient in clinic is an 86-year-old man with a 12-month history of swallowing difficulties.  He reports difficulty swallowing both solids and liquids. He tells you that sometimes he regurgitates food and can choke on both solid and liquids. The onset has been fairly insidious but does not appear to be worsening.  He does not like to eat with his friends and family any longer as he is worried and embarrassed about the choking and regurgitation.  He has lost around half a stone in weight over the last 6 months.    He has suffered from 2 chest infections in the last 6 months. 

His past medical history includes COPD, hypertension, GORD, and a stroke in 2020.  His regular medications include Trelegy inhaler, Ipratropium bromide inhaler, Ramipril, Amlodipine, Atorvastatin, Clopidogrel and Lansoprazole. 

You decide to refer him for an OGD, however he tells you that he does not want to have this test – he has had an OGD 10 years ago, and found it extremely unpleasant and does not want to have another.  

What is your differential diagnosis in this case?

If the patient is not willing to undergo upper GI endoscopy, what other investigations could you consider?  

Please limit your answer to approximately 500 words and submit below in either a word document or pdf format. This assignment should take no longer than 1 hour.