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Clinical presentation
A 68-year-old man with a history of dyspepsia and hiatus hernia presented with 15 kg weight loss with occasional nausea and vomiting episodes over the previous year. He was not taking any regular medication. He underwent gastroscopy, colonoscopy and barium swallow 1 year earlier to investigate change in bowel habit and dyspepsia. These tests revealed hiatus hernia and a non-specific motility disorder of the distal oesophageal segment. Clinical examination was unremarkable.
Blood tests were all normal. An ultrasound scan of the abdomen was normal and repeat gastroscopy again showed only hiatus hernia. A chest x ray, which was performed in view of weight loss and smoking history, was normal.
Symptoms initially improved with regular domperidone; however, vomiting became more frequent and occurred in association...