Dysphagia

Question 1

Dysphagia?

Oesophageal cancer

Answer 1

• Dysphagia may be associated with weight loss, anorexia or vomiting during eating
• Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

Question 2

Oesophagitis?

Answer 2

• May be history of heartburn
• Odynophagia but no weight loss and systemically well

Question 3

Oesophageal candidiasis?

Answer 3

• There may be a history of HIV
• or other risk factors such as steroid inhaler use

Question 4

Achalasia?

Answer 4

• Dysphagia of both liquids and solids from the start
• Heartburn
• Regurgitation of food - may lead to cough, aspiration pneumonia etc

Question 5

Pharyngeal pouch?

Answer 5

• More common in older men
• Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
• Usually not seen but if large then a midline lump in the neck that gurgles on palpation
• Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen

Question 6

Systemic sclerosis?

Answer 6

• Other features of CREST syndrome may be present, namely Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia
• As well as oesophageal dysmotility the lower oesophageal sphincter (LES) pressure is decreased. This contrasts to achalasia where the LES pressure is increased

Question 7

Myasthenia gravis?

Answer 7

• Other symptoms may include extraocular muscle weakness or ptosis
• Dysphagia with liquids as well as solids

Question 8

Globus hystericus?

Answer 8

• May be history of anxiety
  Symptoms are often intermittent and relieved by swallowing
• Usually painless - the presence of pain should warrant further investigation for organic causes

Question 9

Investigations?

Answer 9

• All patients require an upper GI endoscopy unless there are compelling reasons for this not to be performed.
• Motility disorders may be best appreciated by undertaking fluoroscopic swallowing studies.
• A full blood count should be performed.
• Ambulatory oesophageal pH and manometry studies will be required to evaluate conditions such as achalasia for
• Patients with GORD being considered for fundoplication surgery.