Dysphagia. Dr.Krisana Thaitong. Dysphagia. must be distinguished from globus sensation Globus is a sensation of a lump in the throat in which food transport is not limited globus is not related to swallowing and, in fact, may improve with swallowing . Dysphagia. Oropharyngeal dysphagia
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Solids & liquids
♥ cervical osteophytes
♥ hypopharyngeal diverticulum (Zenker's diverticulum)
♥ postcricoid webs
♥ dysphagia for solid & liquid
♥ chest pain
esophagus is dilated with a "bird's beak" tapering of the distal esophagus
Retained secretions form the heteroge-nous air-fluid level seen at the top of the barium column.
sigmoid-like tortuosity with large amount of retained debris.
The aperistalsis is manifested by isobaric contractions without propagation
The LES pressure, which is elevated, shows minimal relaxation with swallowing.
-good short-term results
-2% to 5% risk of perforation
- performed endoscopy uses air pressure to dilate and disrupt the
circular muscle fibers of the LES
by barium swallow to exclude esophageal perforation
-fail repeated pneumatic dilations
-an anterior myotomy across the LES
(Heller's myotomy) usually associated with an antire-flux procedure
is GERD, which occurs in 10% to 20%
-Inhibits release of excitatory acetylcholine from nerve endings (thus causing lower LES pressures)
-Good short-term results, but long term efficacy unknow
-Effective in about; 85% of
patients with chest pain or dysphagia
2.1 Diffuse esophageal spasm (DES)
2.2 Scleroderma or
progressive systemic sclerosis (PSS)
2.3 Other systemic conditions
is the "corkscrew" esophagus
(not completely effective)
(1) mercury-filled, rubber Maloney dilators; (2) wire-guided rigid Savary-Gilliard dilators; (3) balloon dilators that can either be through-the-scope (TT8) or wire guided
food dysphagia, aspiration, and regurgitation.
Los Angeles classification
Extensive linear superficial ulcerations and erosions involving the distal 1/3 of the esophagus.
Surgical resection is the standard treatment for early esophageal cancer in Stages I, II and most cases of III
from neighboring inflammatory or
fibrotic tissue, such as adjacent tuberculous mediastinitis
from acute self-limited esophagitis to refractory strictures