Dysphagia

Definition

• Difficulty swallowing and passing food from the esophagus to the stomach Etiologies (rmj 2003:326:433)

Figure 3-1 Etiologies of and approach to dysphagia

Dysphagia

difficulty with solids only

difficulty with liquids and solids

AT

| Mechanical Obstruction |

1

Motility Disorder |

/ 1 N

/ 1 \

intermittent progressive sx progressive

intermittent progressive sx progressive

sx chronic GERD sx

sx

chronic GERD sx

* ♦ \

*

* \

Esophageal ring Peptic Esophageal

Spasm &

Scleroderma Achalasia

Eos esophagitis stricture cancer

related

disorders

• Barium swallow 1st-line test for both mechanical and motility disorders

• EGD: ideal for structural mechanical lesions: provides limited motility information

• Manometry: if motility disorder suspected following completion of above studies

Achalasia

• Etiology: idiopathic (most common), pseudoachalasia (due to GE junction tumor). Chagas

• Diagnosis: barium swallow dilated esophagus with distal "birds beak" narrowing;

manometry low-amplitude contractions, incomplete relaxation of lower esophageal sphincter (z LES hypertension)

• Treatment: Heller myotomy, pneumatic balloon dilatation (2% risk of esophageal perforation); botulinum toxin injection (primarily used for high-risk surgical candidates)

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