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Dysphagia

Swallowing difficulties (dysphagia) may be attributable to a number of causes. Anyone experiencing swallowing difficulty should see their doctor to have it checked out straight away.

They may be caused by diseases which cause malfunctions in the brain such as Parkinson's, Multiple Sclerosis or Motor Neurone Disease, muscle dysfunction caused by stroke, achalasia whereby the Lower Oesophageal Sphincter doesn't relax sufficiently or stricture or narrowing of the oesophagus which may be due to a tumour.

Swallowing difficulties are usually diagnosed or investigated by a Barium meal or swallow which entails drinking a mildly radioactive liquid and having its progress checked by means of an X-ray scanner. 

Self help

The swallowing process may be assisted by cutting food up small, eating small mouthfulls, chewing well and remaining upright whilst the food bolus traverses the oesophagus. Drinking carbonated water can also assist the swallowing process.

If food remains lodged in the oesophagus for more than about 10 minutes, medical assistance needs to be sought.

Strictures are narrowing of the oesophagus which may be due to many factors. Mostly they are benign and may be due to oesophageal scarring from oesophagitis, a hiatus hernia or dysfunctional lower oesophageal sphincter (achalasia) as described below.

In some cases, strictures can be caused by tumour.

Strictures may be treated by dilation described below or in some cases a stent may be used to hold the oeosphagus open.

Achalasia (or cardiospasm) is a comparatively rare condition whereby the Lower Oesophageal Sphincter may not open properly for food to move into the stomach. We do not know why this develops in some people. It is probably due to damage to nerves in the wall of the oesophagus perhaps caused by a virus in early life.

The various treatment options for achalasia include the following.

Drugs may be prescribed which can relax the muscles. They are usually allowed to dissolve under the tongue half an hour before eating. They relax the pressure on the lower oesophageal sphincter temporarily but are not a long term solution.

Botox (Botulinum toxin) injections delivered endoscopically into the musculature provides sphincter relaxation lasting a few months or up to a year.

Dilation of the oesophago-gastric junction to stretch the opening may be achieved using a mercury filled bougie (a rubber cylinder) that is inserted blindly to the base of the oesophagus or an endoscopically guided balloon that is then inflated at the optimum point. Whereas stents to keep dilations open are often recommended following dilations elsewhere in the body, they are not recommended at the LOS.

Myotomy is surgery usually performed laparoscopically (ie keyhole surgery) to cut the muscle fibres that fail to retract. This provides a permanent solution but may have complications.

PerOral Endoscopic Myotomy (POEM) is a new technique that is currently being evaluated whereby the surgical procedure is conducted via and endoscope.

Complications of any treatment for achalasia include promotion of acid reflux because of the need to keep the LOS relaxed. Frequently fundoplication is offered at the same time as myotomy. [See chapter on fundoplication.]