Dysphagia in patients with gastric cancer and a normal esophagram

Five patients presented with dysphagia but did not have abnormal esophageal motility or morphology on the esophagram. Each was found to have a malignant gastric tumor which did not appear to involve the gastroesophageal junction, and this was confirmed surgically in 2 cases. In 2 patients, diagnosis was delayed as a result of failure to examine the stomach following a normal esophagram. In the absence of abnormal esophageal motility, changes involving the gastroesophageal junction, or cerebral metastases, it is postulated that the dysphagia represented a nonspecific regional response to functional obstruction of the upper gastrointestinal tract secondary to an infiltrating neoplasm of the stomach. The fact that the esophagram was normal emphasizes the possibility that gastric lesions in patients with dysphagia may be missed when only a routine esophagram is employed. The authors recommend that the stomach be examined when no apparent cause for dysphagia can be discerned above the gastroesophageal junction.