Anastomotic Stricture: This is a common complication following total gastrectomy, especially if the patient has a history of gastric cancer. The stricture can cause narrowing of the anastomosis site, leading to dysphagia.

Esophageal Dysmotility: Post-surgical changes and potential damage to the esophageal muscles during the gastrectomy can lead to dysmotility, causing difficulty in swallowing.
Gastroesophageal Reflux Disease (GERD): Although less common after gastrectomy, GERD can still occur, especially if the patient has a history of reflux or if the surgery altered the normal anatomy, leading to dysphagia.
Adhesions or Scarring: Post-operative adhesions can form and cause mechanical obstruction, leading to dysphagia.

Recurrent Gastric Cancer: Although less likely, recurrence of gastric cancer at the anastomotic site or elsewhere can cause dysphagia and is critical to diagnose early.
Esophageal Cancer: Given the patient's history of gastric cancer, there is an increased risk of developing esophageal cancer, which can present with dysphagia.
Pulmonary Embolism: While not directly related to dysphagia, in a patient with a history of cancer and recent surgery, pulmonary embolism can cause sudden onset of dyspnea that might be confused with dysphagia and is a life-threatening condition.

Eosinophilic Esophagitis: An inflammatory condition of the esophagus that can cause dysphagia, though it is less common in this patient population.
Scleroderma: A systemic disease that can affect the esophagus, leading to dysmotility and dysphagia, but is rare and would require other systemic symptoms for consideration.
Zenker's Diverticulum: A condition where a pouch forms in the pharynx, which can cause dysphagia, but is less likely in this context without other specific symptoms.