Dysphagia

Question 1

What is Dysphagia?

Answer 1

Difficulty swallowing

Question 2

What is Odynophagia?

Answer 2

Pain upon swallowing

Question 3

What are the common causes of Dysphagia?

Answer 3

Diseases of mouth/tongue
Neuromuscular disorders
Oesophageal motility disorders
Extrinsic pressure
Intrinsic lesion

Question 4

What are the two main types of Dysphagia?

Answer 4

Oropharyngeal

Oesophageal

Question 5

What are the features of Oropharyngeal Dysphagia?

Answer 5

Difficulty initiating swallow +/- choking/aspiration

Question 6

What are the causes of Oropharyngeal Dysphagia?

Answer 6

Neurological disease (bulbar palsy/MG)

Question 7

What are the appropriate investigations in suspected Oropharyngeal Dysphagia?

Answer 7

Neurological examination

Videofluoroscopic swallowing assessment

Question 8

What are the features of Oesophageal Dysphagia?

Answer 8

Food sticks after swallowing +/- regurgitation

Question 9

What are the causes of Oesophageal Dysphagia?

Answer 9

Dysmotility
Stricture
Oesophagitis
Pharyngeal pouch

Question 10

What are the appropriate investigations in suspected Oesophageal Dysphagia?

Answer 10

Barium swallow
Endoscopy (OGD)
Biopsy

Question 11

What features suggest a malignant background?

Answer 11

Short hx of progressive dysphagia
Severe wt loss
Elderly pts

Question 12

What features suggest a dysmotility (Achalasia) background?

Answer 12

Long hx of non-progressive dysphagia
No wt loss
Young pts

Question 13

What is Plummer-Vinson syndrome?

Answer 13

Pre-malignant condition due to hyperkeratinisation of oesophagus (causing oesophageal web)
Triad of sx
   -dysphagia
   -koilonychia
   -glossitis

Question 14

What is the management of Plummer-Vinson syndrome?

Answer 14

Iron

Dilation of web via OGD

Question 15

What are the sx of an oesophageal malignancy?

Answer 15

>60yrs
Progressive dysphagia (solids --> liquids --> saliva)
Wt loss/anorexia
Retrosternal chest pain
Coughing/aspiration
Lymphadenopathy

Question 16

What are the main types of oesophageal malignancy?

Answer 16

Mostly in lower 1/3

Mainly adenocarcinomas, some SCCs

Question 17

What are the features of oesophageal adenocarcinomas?

Answer 17

Risk factors related to GORD (Barratt’s)

Metastasise earlier than SCC (lymphatic spread)

Question 18

What are the features of oesophageal SCCs?

Answer 18

Occur in heavy smoking/drinking males
Present late due to lumen compromise (dysphagia)
Regional lymph node spread early/common

Question 19

What is the prognosis for oesophageal malignancy?

Answer 19

Poor (<10% 5yr survival)

• SCC slightly better (responsive to radiotherapy)
• mets common at diagnosis (25%)

Question 20

Where are the common sites of metastasis for oesophageal malignancy?

Answer 20

Liver
Lungs
Bones

Question 21

What are the appropriate investigations for suspected oesophageal malignancy?

Answer 21

OGD w/ transoesophgeal USS/biopsy
CT thorax/abdo
PET
Laparoscopy

Question 22

What are the management options for oesophageal malignancy?

Answer 22

Radical curative oesophagectomy for T1/T2 localised disease
Pre-op chemo
Chemo/radio combinations (if surgery not indicated)
Oesophageal stenting (palliative, restores swallow)

Question 23

What is Achalasia?

Answer 23

Dysmotility problem due to lack of coordinated muscle contraction/relaxation at the lower end of the oesophagus
-leads to retention of food bolus

Question 24

What are the presenting sx of Achalasia?

Answer 24

Dysphagia
Regurgitation
Substernal cramps
Nocturnal cough
Wt loss
20-30yrs

Question 25

What are the appropriate investigations in suspected Achalasia?

Answer 25

Barium swallows
OGD (dilated oesophagus, stagnant food/fluid)
Oesophageal manometry (increased lower sphincter pressure)

Question 26

What is the main complication of Achalasia?

Answer 26

Predisposes to development of oesophageal carcinoma

Question 27

What are the management options for Achalasia?

Answer 27

Conservative/lifestyle (chew food well, eat upright, drink lots w/ meals)
Botox injection
Endoscopic balloon dilation (risk of rupture)
Heller’s cardiomyotomy