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DYSPHAGIA

DYSPHAGIA. Mr Andrew Lale Consultant ENT surgeon. SWALLOWING. “5 minute consultation” CAUSES: Acute Neurogenic Globus pharyngeus Laryngopharyngeal reflux Strictures and narrowing Pharyngeal Pouches . CONSULTATION. True Dysphagia or feeling of a lump? Dysphagia for what?

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DYSPHAGIA

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  1. DYSPHAGIA Mr Andrew Lale Consultant ENT surgeon

  2. SWALLOWING • “5 minute consultation” • CAUSES: • Acute • Neurogenic • Globus pharyngeus • Laryngopharyngeal reflux • Strictures and narrowing • Pharyngeal Pouches

  3. CONSULTATION • True Dysphagia or feeling of a lump? • Dysphagia for what? • Regurgitation or Aspiration? • Gastro-oesophageal reflux current or past? • Change of Diet or weight loss? • Odynophagia

  4. ACUTE DYSPHAGIA • History: FB. Previous problems. • Examination: Drooling. Pain. Pyrexia. Odynophagia • Treatment: • Food bolus: Buscopan, fizzy drink, refer at 1 hour • FB: Refer

  5. Foreign bodies

  6. Strictures and narrowing • Malignant/benign • Cricopharyngeal bar • C-spine osteophytes • Kyphosis • Post cricoid web

  7. Cricopharyngeal bar

  8. Osteophytes

  9. Neurogenic • CVA • Motor neurone disease • Multiple Sclerosis • Parkinson’s disease • Myaesthena gravis

  10. GLOBUS PHARYGEUS • Previously Globus Hystericus • Worse when NOT eating or drinking • No true dysphagia solids/liquids • No odynophagia • No reguritation/aspiration • Variable history. ?exclude reflux…..

  11. Laryngopharyngeal Reflux (LPR) • Reflux of gastric acid to larynx/pharynx • May be “silent” • Symptoms include feeling of a lump, odynophagia/chronic sore throat, chronic cough (especially nightime), hoarse voice and “mucous in throat”.

  12. LPR Investigations • Nasopharyngoscopy, red post cricoid region. • ? Barium swallow? • Oesophageal pH manometry

  13. LPR treatment • 6 weeks PPI + Gaviscon initially • At review further 6 weeks treatment if improving • General laryngeal hygiene measures • If no better, rigid pharyngo-oesophagoscopy • pH manometry ?fundoplication

  14. Pharyngeal pouches • HISTORY • Long Hx dysphagia • Regurgitation esp at night • “gurgling” swallow • Aspiration (recurrent pneumonia) • Weight loss and change in Diet.

  15. Pharyngeal Pouches • EXAMINATION • Nasopharyngoscopy might show pooling • Unlikely to feel anything in neck • Barium swallow

  16. Pharyngeal pouches • TREATMENT • Surgical if fit for GA • (External approach) • Endoscopic stapling, low morbidity and high success rate.

  17. Pouches

  18. Pouches

  19. Summary :Fast track patients • Young male patient • Short history • Odynophagia • Smoking and Alcohol • Weight loss • Aspiration and reguritation

  20. Summary: Globus patients • Variable history • No true dysphagia • Young female • No weight loss • Associated anxiety

  21. Summary: Pouch patients • Older male/female • REGURGITATION • Gurgling swallow • Recurrent chest infections • Weight loss

  22. Thankyou

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