LA DISFAGIA IN GASTROENTEROLOGIA Istituto Leonardo da Vinci GIORNATE MEDICHE FIORENTINE 2015 Auditorium al DUOMO Firenze, 20/21/22 Novembre 2015 Coordinatori del Congresso: Simone Mininni, Mauro Vannucci   LA DISFAGIA IN GASTROENTEROLOGIA Giacomo Trallori Gastroenterologia Istituto Leonardo da Vinci Firenze

ESOFAGO

DISFAGIA Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.

DISFAGIA Esophageal dysphagia refers to the sensation of food sticking or getting hung up in the base of your throat or in your chest after you've started to swallow.

Etiology Dysphagia is classified as oropharyngeal or esophageal, depending on where it occurs.

the causes of esophageal dysphagia include: Achalasia Diffuse spasm Esophageal stricture Esophageal tumors Foreign bodies Esophageal ring Gastroesophageal reflux disease (GERD). Eosinophilic esophagitis Scleroderma Radiation therapy

Signs and symptoms associated with dysphagia Having pain while swallowing (odynophagia) Being unable to swallow Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum) Drooling Being hoarse

Signs and symptoms associated with dysphagia Bringing food back up (regurgitation) Having frequent heartburn Having food or stomach acid back up into your throat Unexpectedly losing weight Coughing or gagging when swallowing Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing

Tests and diagnosis X-ray with a contrast material (barium X-ray). A visual examination of your esophagus (endoscopy) Esophageal muscle test (manometry) Imaging scans. 

BARIUM X RAY AND ACHALASIA

ENDOSCOPY

MANOMETRIA ESOFAGEA

MANOMETRIA ESOFAGEA

MANOMETRIA ESOFAGEA

Treatment approaches for esophageal dysphagia may include: Esophageal dilation.  For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).

DILATAZIONE PNEUMATICA

Treatment approaches for esophageal dysphagia may include: Botulinum toxin (botox) - commonly used if the muscles in the esophagus have become stiff (achalasia). Botulinum toxin, a strong toxin, can paralyze the stiff muscle, reducing constriction.

Procedure Botulinum toxin A is available commercially in the form of a lyophilized powder in vials of 100 units It is reconstituted immediately prior to administration, typically to a concentration of 20 units/mL.  For achalasia, the most common dose is 80 to 100 units, injected in 1-mL aliquots (20 to 25 units BoT/mL) in each of four quadrants about 1 cm above the Z-line or endoscopically visible sphincter rosette using a sclerotherapy needle through the channel of an endoscope.

Complications After a decade of use, BoT-A injections for achalasia can generally be considered safe. The low dose of toxin used for treatment of achalasia has virtually no risk of causing generalized neuromuscular blockade or paralysis. Immediate postprocedural transient and minor chest pain is reported in up to 25%, and heartburn may occur in up to 5% of patients.

Treatment approaches for esophageal dysphagia may include: Surgery.  For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.

HELLER MYOTOMY SURGERY

Treatment approaches for esophageal dysphagia may include: Medications.  Difficulty swallowing associated with GERD can be treated with prescription oral medications to reduce stomach acid. You may need to take these medications for an extended period. If you have eosinophilic esophagitis, you may need corticosteroids.

Lifestyle and home remedies Changing your eating habits.  Try eating smaller, more-frequent meals. Be sure to cut your food into smaller pieces and eat more slowly.

Lifestyle and home remedies Trying foods with different textures to see if some cause you more trouble Thin liquids, such as coffee and juice, are a problem for some people, and sticky foods, such as peanut butter or caramel, can make swallowing difficult. Avoid foods that cause you trouble.

Lifestyle and home remedies Avoiding alcohol, tobacco and caffeine.  These can make heartburn worse.

Prevention Although swallowing difficulties can't be prevented, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well. Early detection and effective treatment of GERD can lower your risk of developing dysphagia associated with an esophageal stricture.

What are the complications of dysphagia? Pneumonia and upper respiratory infections - specifically aspiration pneumonia which can occur when you swallow something down the wrong way and it enters the lungs. Malnutrition - this is especially the case with people who are not aware of their dysphagia and are not being treated for it. They may simply not be getting enough vital nutrients for good health.  Dehydration - if you cannot drink properly, your fluid intake may be undermined, leading to dehydration (shortage of liquid in the body).