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Gastro-oesophageal Reflux Disease — MRCGP AKT MCQ

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EasyGastroenterologyGastro-oesophageal Reflux DiseaseMRCGP AKT

A 62-year-old man with previous intermittent reflux now reports three weeks of progressive difficulty swallowing solid food. He has lost 4 kg unintentionally. Examination is unremarkable. What is the most appropriate next step?

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Correct answer: D — Refer on the suspected upper-gastrointestinal cancer pathway

Progressive dysphagia is itself an indication for suspected-cancer-pathway referral for oesophageal or gastric malignancy, and weight loss further heightens concern. Empirical escalation of acid suppression, H. pylori testing or routine imaging must not delay endoscopic assessment. Reflux history does not make new dysphagia benign. The referral should convey progression, weight loss, nutritional impact and relevant comorbidity. Complete obstruction, inability to swallow liquids or aspiration would require acute admission rather than an outpatient pathway.

Reference: NICE. Suspected cancer: recognition and referral (NG12), recommendations by symptom. https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-symptom-and-findings-of-primary-care-investigations