Anne, a 92-year-old retired dressmaker, presents to her local doctor with increasing constipation and abdominal distension.

Anne reports also experiencing effortless regurgitation to the throat after eating and minor stable dysphagia for more solid foods.

She has noticed upper abdominal bloating and early satiety and feels tired. She also reports worsening moderate dyspnoea on exertion, especially post-prandially.

There is no heartburn, PR bleeding, weight loss or anorexia. She otherwise manages fairly well at home alone with the assistance of family. She is a lifelong non-smoker.