DYSPHAGIA

Begashaw M (MD)

Dysphagia

DefnDifficulty in swallowingClassification 1- Oropharyngeal dysphagia Causes– Local pain -trauma, oral candida, tonsillitis _Neuromuscular-Parkinson’s disease _Mechanical causes-Tumor2- Esophageal dysphagiaCauses – Mechanical - foreign body, tumor - Dysmotility - achalasia

Diagnosis

History- Dysphagia to solids or

liquids- Progressive, static or

intermittent- Duration- Associated pain, heart

burn or weight loss

Examination -weight loss-emaciation-chest aspiration pneumonia

Investigations

Barium swallow EsophagoscopyEndoscopic ultrasoundManometry

Achalasia

Etiology - motility disorder of the esophagus due to loss of ganglion cells in auerbach’s plexus

Pathophysiology - Incomplete relaxation of lower oesophageal

sphinictor (LES) - Stasis esophageal dilatation (functional

obstruction) - Risk for cancer (Ca), in long standing cases

Clinical feature - Age 20-40 years - Progressive dysphagia (insidious onset) regurgitation - Retrosternal discomfort, fetid flatulence & aspiration pneumonitisDiagnosis -Barium swallow: rat tail tapering, dilated esophagus, no gas in

stomach - Esophagoscopy - manometryTreatment: Heller’s cardiomyotomy

Achalasia

Carcinoma of the esophagus

Epidemiology > 60 years M > F 5% of all cancersPredisposing factors Ingestion of hot meal Smoking Alcohol intake

PathologyMicroscopic: squamous cell carcinoma,

Adeno carcinomaMacroscopically: Annular stenosing, ulcer,

fungating, cauli flower likeSpreadDirect, lymphatic and blood stream to liver

and bone

Clinical feature -Dysphagia, regurgitation, anorexia, weight lossDiagnosis- Barium swallow - Irregular, ragged pattern of mucosa

with narrow lumen- Esophagoscopy & biopsy- Bronchoscopybronchial involvement- U/S - liver secondaries- Hgb, plasma proteins, blood chemistry

TreatmentCurative - surgery- RadiotherapyPalliative - Intubation with specially designed tubes- Radiotherapy

Foreign bodies

_Coins, pins, dentures..Diagnosis - Radiography (neck and chest x-ray) - EsophagoscopyTreatment - Removal by rigid esophagoscope

Oesophagitis

Acute - burns or scalds- Infective - candidiasis- PepticChronic - reflux due to hiatus hernia or previous surgeryPathology- Bleeding granulation tissue replaces epithelium-

upward displacement of the cardia

Clinical features- Pain, heart burn, dysphagia, occult blood, secondary

anemiaDiagnosis - Barium swallow, esophagoscopyTreatment - treat the cause, H2 blockers, omeprazole – reflux

(peptic)- surgery for sliding hernia

Caustic strictures

Treatment - acute inflammatory stage NPO antibiotics cortisone- stricture dilation esophageal replacement