DYSPHAGIA Begashaw M (MD)

Dysphagia Defn  Difficulty 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 Esophagoscopy Endoscopic ultrasound Manometry

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 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

Pathology Microscopic: squamous cell carcinoma, Adeno carcinoma Macroscopically: Annular stenosing, ulcer, fungating, cauli flower like Spread Direct, 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 - Bronchoscopy  bronchial 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