In a patient with a history of neck radiation therapy experiencing difficulty swallowing solids, what is the most appropriate therapy?

In patients who have undergone radiation therapy to the neck, it's not uncommon to experience complications such as esophageal strictures or dysphagia (difficulty swallowing). This can happen because radiation can damage normal tissues, leading to scarring and narrowing of the esophagus over time.

Mechanical dilation becomes the most appropriate therapy in this scenario because it directly addresses the physical obstruction or narrowing of the esophagus, allowing for improved passage of solids. This is a procedure performed endoscopically where a dilator is used to expand the esophagus, providing symptomatic relief for the patient.

Other treatment options, such as initiating H-2 antagonist or proton pump inhibitor therapy, may help manage acid reflux symptoms but do not address mechanical obstructions. Surgical resection may be too invasive or unnecessary unless there is a significant mass or structural issue that needs removal. Therefore, mechanical dilation focuses on alleviating the swallowing difficulty caused by structural changes resulting from prior radiation, making it the most appropriate choice in this clinical situation.