Today we'll talk about disorders of the esophagus.
So let's go through some important definitions first.
Dysphagia is when patients have difficulty with swallowing.
Whereas odynophagia is when patients have pain with swallowing.
In addition, dysphagia can be grouped into oropharyngeal dysphagia which is when patients --
people have difficulty passing food from the oropharynx to the upper esophagus or they may have esophageal dysphagia
which is when they have difficulty passing food from the upper esophagus down to the stomach.
So some important things that you always wanna ask your patients about are;
do they have dysphagia to solids, liquids, or both?
Do they have any associated symptoms like weight loss, hoarseness, dysarthria, or regurgitation?
What medications do they take? Do they have a history of smoking or alcohol use?
And do they have a history of gastroesophageal reflux disease or GERD or acid reflux?
The type of food with which a patient describes having dysphagia can help you also determine the underlying etiology.
If they just have dysphagia to solids then it's usually a mechanical obstruction.
If they have dysphagia to liquids or both solids and liquids, this indicates probably a motility disorder or a complete obstruction.
So in general, the best diagnostic test that can be done to help you make this diagnosis include a barium swallow
which is where you have a patient drink barium contrast
and then take x-rays to show the passage of the barium through the esophagus.
Here you can see an example of a barium swallow that shows a dilated esophagus
with the typical bird's beak appearance of achalasia.
You may also do an upper endoscopy to look for mechanical obstructions.
And you may also do esophageal manometry.
This is testing of the pressure along the length of the esophagus as the patient swallows.
Lastly, you can also do something called pH monitoring.
This involves inserting a pH probe through the patient's nose that then sits on the esophagus and monitors the pH over time.
This is helpful in making a diagnosis of gastroesophageal reflux disease when it's otherwise unclear.