Associate Prof. Dr. Meltem Ergun

Presentation on theme: "Associate Prof. Dr. Meltem Ergun"— Presentation transcript:

1 Associate Prof. Dr. Meltem Ergun
Dysphagia Associate Prof. 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 CLASSIFICATION Two 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
Oropharyngeal dysphagia 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 Diffuse oesophageal spasm
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

14 Dysphagia Odynophagia Globus (pain in swallowing=odinophagia) Globus= something in my throat

15 Stable, intermittent, progressive
History Duration Stable, intermittent, progressive Speed of progression Liquids or solids

16 Alendronate (for Osteoporosis)
History Hx of drugs Tetracycline Alendronate (for Osteoporosis) Kostic injury

17 Diagnostic laparoscopy
Investigations Diagnostic Endoscopy Barium swallow Manometry Staging CT Diagnostic laparoscopy EUS

18 Biopsies Dilatation Stenting / laser ablation

19

20

21

22 Investigations for Staging
CT or MRI EUS Staging laparoscopy

23 Manometry -patients with no structural abnormality on endoscopy

24 Normal Swallow

25 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

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

27 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

28

29 Achalasia Tracing

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

31

32

33 Odinophagia

34

35

36

37

38