Dysphagia

Dr. Raid Jastania

Reference and Contact

• Robbins Basic Pathology• http://www.pathoma.com/

• Jastania@hotmail.com• http://uqu.edu.sa/staff/ar/4180114

Before we start:

• 70 year old man presented with difficulty in swallowing. It started with difficulty in swallowing solid food. Later he had difficulty in swallowing liquids too.

• Barium swallow shows stricture in the lower esophagus. Endoscopy is done and a biopsy is taken.

Before we start

• What are the diseases causing problems in swallowing?

• What are the symptoms of Diseases in swallowing?

• What is the normal physiology and the abnormal pathophysiology of swallowing?

• What are the common disease of esophagus?

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Definitions:

• Dysphagia is: a sensation of “sticking” or obstruction of food through the mouth, pharynx or the esophagus

• Apahgia is: complete esophageal obstruction• Odynophagia: is painful swallowing

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Swallowing

• Oral phase: • voluntary

• Pharyngeal phase: • involuntary deglutition

reflex

• Esophageal phase: • deglutition inhibition, • Peristalsis

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Pathophysiology of dysphagia

• What are the structures involved (controls) swallowing?

Pathophysiology of dysphagia

• What are the structures involved (controls) swallowing?– Nervous system, vagus nerve– Mouth, tongue– Pharynx, larynx, esophagus– Skeletal muscle– Smooth muscle– Upper and lower esophageal sphincter

Pathophysiology of dysphagia• What are the structures involved (controls) swallowing?

– Nervous system, vagus nerve– Mouth, tongue– Pharynx, larynx, esophagus– Skeletal muscle– Smooth muscle– Upper and lower esophageal sphincter

• Pathology can be:– Structural or– Functional

• In the Esophagus: Pathology can be:– Mechanical or– Motor

Mechanical Dysphagia

• Obstruction:– Large food bolus– Narrowing of the esophagus– Compression of the esophagus

Mechanical Dysphagia

• Obstruction:– Large food bolus– Narrowing of the esophagus

– Inflammatory: esophagitis– Developmental: web, ring– Stricture: congenital, peptic, inflammatory– Neoplasm: Benign, Malignant

– Compression of the esophagus– Retropharyngeal mass– Mediastinal mass– Pancreatic tumor

Motor Dysphagia

• Disease in striated muscle:– Pharynx, upper esophageal sphincter, upper

esophagus– Cerebrovascular accident– Polymyositis, dermatomyositis

• Disease in the smooth muscle:– Mid and lower esophagus, Lower esophageal

sphincter– Achalasia– Scleroderma

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Developmental Defects in the Esophagus

• Esophageal Atresia:– Absence of lumen– Newborn with aspiration

• Trachio esophageal Fistula

Developmental Defects in the Esophagus

• Esophageal Ring and Web:– Episodic dysphagia to

solid food

Developmental Defects in the Esophagus

• Esophageal Diverticula:– Episodic food

regurgitation, – may be painful

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Esophagitis

• Inflammation of the esophagus

• Start in the mucosa• Causes:

• Intubation• Corrosoives, irritant,

acidity• Chemotherapy• Reflux esophagitis• Hiatal hernia• infections

Barrett Esophagus

• Replacement of the normal stratified squamous epithelium with intestinal (goblet cell) metaplasia

• Complication of reflux disease

• Complications: ulceration, stricture, dysplasia, carcinoma 30-100 x risk

Esophageal Carcinoma

• Squamous cell carcinoma

• Adenocarcinoma• Risk factors:– Esophagitis– Barrett– Achalasia– Alcohol– Smoking

By the end of this session the student should be able to:

• Define dysphagia, odynophagia, aphagia,

• Describe the physiological process of swallowing

• Develop an approach to list the etiological causes of dysphagia

• Compare Mechanical dysphagia and motor dysphagia

• Describe common developmental defects: Atresia, rings, web diverticula

• Explain Reflux esophagitis, Barrett esophagus

• List common types of carcinoma of esophagus

Further questions and reading

• What is the role of Salivary glands in swallowing?

• What are the signs and symptoms of diseases of the GI tract?

• What are the diseases of the stomach, small and large intestine?