Dysphagia

Oesophagus

Dysphagia

·        =Difficulty swallowing

·        Define level and whether progressive or intermittent

·        History: Time course, reflux symptoms, cough, asthma, chest infections, weight loss, pain

·        Examination:

o   Lymphadenopathy

o   Chest signs: consolidation, effusion

o   Hepatomegaly

o   Ascites

o   Raynaud‟s: connective tissue disorders

·        Investigations:

o   Barium swallow (video)

o   CT scan: staging malignancy

o   Endoscopy: assess mucosa, strictures

o   Manometry: assess motility

·        Oesophageal motility causes:

o   Fluids get through OK, solids the problem

o   Pharynx: neurological diseases causing failure of high pressure contraction

o   Cricopharyngeal sphincter: failure due to cricopharyngeal spasm or pharyngeal pouch

o   Oesophagus: failure of peristaltic wave due to diffuse oesophageal spasm

o   Cardiac sphincter: failure of opening due to achalasia

·        Oesophageal obstruction causes:

o   Fluids also a problem

o   Extrinsic compression: thyroid, other neck mass, lymph nodes (Ca lung) 

o   Carcinoma of the oesophagus. Often diagnosed at advanced stage. Either squamous or adenocarcinoma. Diagnosis by endoscopy + biopsy +/- CT. Treatment – surgical reconstruction. Palliation: radiation + internal stent 

o   Reflux stricture of the lower oesophagus