DYSPHAGIA

Begashaw M (MD)

Dysphagia

DefnDifficulty in swallowing

Classification

1- Oropharyngeal dysphagia

Causes– Local pain -trauma, oral candida, tonsillitis

_Neuromuscular-Parkinson’s disease

_Mechanical causes-Tumor

2- Esophageal dysphagia

Causes – 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 pneumonitis

Diagnosis

-Barium swallow: rat tail tapering, dilated esophagus, no gas in stomach

- Esophagoscopy

- manometry

Treatment: Heller’s cardiomyotomy

Achalasia

Carcinoma of the esophagus

Epidemiology

> 60 years M > F

5% of all cancers

Predisposing factors

Ingestion of hot meal

Smoking

Alcohol intake

PathologyMicroscopic: squamous cell carcinoma,

Adeno carcinomaMacroscopically: Annular stenosing, ulcer,

fungating, cauli flower like

SpreadDirect, lymphatic and blood stream to liver

and bone

Clinical feature

-Dysphagia, regurgitation, anorexia, weight loss

Diagnosis

- Barium swallow - Irregular, ragged pattern of mucosa with narrow lumen

- Esophagoscopy & biopsy

- Bronchoscopybronchial involvement

- U/S - liver secondaries

- Hgb, plasma proteins, blood chemistry

Treatment

Curative

- surgery

- Radiotherapy

Palliative

- Intubation with specially designed tubes

- Radiotherapy

Foreign bodies

_Coins, pins, dentures..

Diagnosis

- Radiography (neck and chest x-ray)

- Esophagoscopy

Treatment

- Removal by rigid esophagoscope

Oesophagitis

Acute

- burns or scalds

- Infective - candidiasis

- Peptic

Chronic

- reflux due to hiatus hernia or previous surgery

Pathology

- Bleeding granulation tissue replaces epithelium- upward displacement of the cardia

Clinical features

- Pain, heart burn, dysphagia, occult blood, secondary anemia

Diagnosis

- Barium swallow, esophagoscopy

Treatment

- 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