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Dysphagia

Dysphagia. Associate Prof. Dr. Meltem Ergun Yeditepe University Department of Gastroenterology. Learning Objectives. What is dysphagia? What are types of dysphagia? What are the causes of dysphagia? How to investigate a patient with dysphagia?. Difficulty in swallowing = dysphagia

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Dysphagia

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  1. Dysphagia AssociateProf. Dr. Meltem Ergun Yeditepe University Department of Gastroenterology

  2. Learning Objectives • What is dysphagia? • What are types of dysphagia? • What are the causes of dysphagia? • How to investigate a patient with dysphagia?

  3. Difficulty in swallowing=dysphagia • Dysphagia suggests the presence of an organic abnormality in the passage of solids or liquids from the oral cavity to the stomach. • Patients' complaints range from the inability to initiate a swallow to the sensation of solids or liquids being hindered during their passage through the esophagus into the stomach.

  4. Dysphagia is an alarm symptom that warrants immediate evaluation to define the exact cause and initiate appropriate therapy. Dysphagia in older adult subjects should not be attributed to normal aging. Aging alone causes mild esophageal motility abnormalities, which are rarely symptomatic

  5. Swallowing • Oral phase • Pharyngeal phase • Esophageal phase

  6. CLASSIFICATIONTwo distinct syndromes Oropharyngeal dysphagia Esophageal dysphagia Produced by abnormalities affecting the finely tuned neuromuscular mechanism of the striated muscle of the mouth, pharynx, and UES Caused by the variety of disorders affecting the smooth muscle esophagus

  7. Oropharyngeal dysphagia • Oropharyngealdysphagia is characterized by difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. • It is a transfer problem caused by • impaired ability to transfer food from mouth to upper esophagus • impaired oral preparatory phase • Clinical presentation: • food sticking in the throat • difficulty initiating a swallow • nasal regurgitation • coughing during swallowing • They may also complain of • dysarthria • nasal speech because of associated muscle weaknesses • Other Neurological clinical findings

  8. Oropharyngeal Dysphagia Neuromuscular • CVA • Parkinson’s disease • MS • Mysthania gravis • Muscular dystrophy • Bulbar / pseudobulbar palsy

  9. Abnormalities Causing Oropharyngeal Dysphagia • Local Structural Lesions • Inflammatory • Pharyngitis • Abscess • Tuberculosis • Syphilis • Neoplastic • Congenital webs • Plummer-Vinson syndrome • Extrinsic compression • Thyromegaly • cervical spine hyperostosis • Lymphadenopathy • Surgical resection of the oropharynx

  10. Esophageal Dysphagia Motility disorders • Achalasia • Diffuse oesophageal spasm • Chaga’s disease

  11. Etiology Of Esophageal Dysphagia Neuromuscular (Motility) Disorders • Most common • Achalasia • Scleroderma • Diffuse esophageal spasm • Other associated motility abnormalities • Nutcracker esophagus • Hypertensive lower esophageal sphincter • Vigorous achalasia • Nonspecific esophageal dysmotility • Other secondary motility disorders • Other collagen disorders • Chagas disease

  12. Etiology Of Esophageal Dysphagia Mechanical Lesions, Intrinsic • Most common • Peptic stricture • Lower esophageal (Schatzki) ring • Carcinoma • Other • Esophageal webs • Esophageal diverticula • Benign tumors • Foreign bodies

  13. Dysphagia • Odynophagia • Globus • (pain in swallowing=odinophagia) • Globus= something in my throat

  14. History • Duration • Stable, intermittent, progressive • Speed of progression • Liquids or solids

  15. History • Hx of drugs • Tetracycline • Alendronate (for Osteoporosis) • Kostic injury

  16. Investigations Diagnostic • Endoscopy • Barium swallow • Manometry Staging • CT • Diagnostic laparoscopy • EUS

  17. Biopsies • Dilatation • Stenting / laser ablation

  18. Investigations for Staging • CT or MRI • EUS • Staging laparoscopy

  19. Manometry-patients with no structural abnormality on endoscopy

  20. Normal Swallow

  21. Esophageal Motility Disorders Achalasia-Etiology • A primary esophageal motility of unknown cause • characterized by insufficient LES relaxation and loss of esophageal peristalsis • hereditary, degenerative, autoimmune, and infectious factors as possible causes

  22. Oesophageal Motility Disorders Achalasia - Symptoms • Dysphagia – usually slowly progressive • Regurgitation • Chest pain and dysphagia • Reflux symptoms

  23. Oesophageal Motility Disorders Achalasia-Manometric features • Normal to raised LOS resting pressures • LOS fails to relax to gastric baseline • Raised residual pressures • Raised oesophageal baseline pressures • Absent or chaotic low amplitude simultaneous peristalsis

  24. Achalasia Tracing

  25. Oesophageal Motility disorders Achalasia-Treatment • Pneumatic dilatatation • Risks • Patient selection • Botox injection • Patient selection • Surgery • Gastro-oesophageal reflux a significant complication

  26. Odinophagia

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