Caustic Strictures of the Esophagus

A 2-year-old boy is brought to your clinic by his parents for a 6-week history of progressive difficulty swallowing and occasional vomiting with meals. Two months ago, he was found holding an open bottle of liquid drain cleaner and had one episode of non-bilious, non-bloody vomiting. He was taken to an urgent care center, where he appeared well and was sent home with advice to follow a soft diet. Since then, he has developed increasing reluctance to eat solid foods, now tolerating only purees and liquids. He has fallen from the 50th to the 10th percentile for weight. Physical examination is notable for a thin, but alert child with no oral burns or respiratory distress. Vital signs are normal.