Behçet’s disease is a rare, chronic, multisystemic disorder with heterogeneous clinical presentations, ranging from mucocutaneous to neurological, arterial and ocular involvement. Gastrointestinal manifestations occur in 1 to 60% of patients, with marked geographic disparity. Oesophageal involvement is exceptionally rare and may result in substantial morbidity. We describe a 67-year-old woman with Behçet’s disease with recurrent food impaction, progressive dysphagia, and marked weight loss. Endoscopies revealed oesophageal ulceration and narrowing; barium transit study showed marked proximal oesophageal stenosis. Despite treatment with glucocorticoids, colchicine and azathioprine, dysphagia and stenosis worsened and oesophageal dilatation was considered unsafe due to mucosal friability. Biological treatment with adalimumab was initiated, leading to clinical stabilization and no further progression of the stenosis. This case illustrates a rare and severe manifestation of Behçet’s disease and highlights the diagnostic and therapeutic challenges of oesophageal involvement. A review of published cases suggests that oesophageal BD remains under-recognized, with biologic therapy emerging as a promising option in refractory disease. Early suspicion is essential in patients with unexplained dysphagia to prevent irreversible complications.