Today in 5-minute refresher lectures I will be discussing dysphagia. These lectures are setup to give busy GPs a general overview and some “pearls of wisdom”. Please always consult your local guidelines for patient management and seek expert advice if unsure.

VIDEO WILL BE ADDED SOON

Dysphagia is a “red flag” symptom, should be taken seriously and trigger prompt investigations.

Difficulty swallowing, or dysphagia is often confused with odynophagia which is painful swallowing. Odynophagia is a much more benign condition caused by inflammation in the oesophagus. The most common causes for oesophagitis are reflux, infections like candidiasis and drugs like NSAIDs or bisphosphonates. First line treatment for odynophagia is high dose PPI and stopping any aggravating medications.

Globus sensation is a functional oesophageal disorder in which patients feel a lump or irritation in their throat that is not due to any structural disorder, motility disorder or reflux.

History is extremely important to determine the cause of dysphagia. Swallowing involves a complex orchestration of different muscle contraction and relaxation. Dysphagia can broadly be divided into:

1: oropharyngeal dysphagia: Patients have difficulty initiating swallow, liquids are worse and may cough when swallowing, Causes include strokes, but also many other neurological conditions such as multiple sclerosis.

2a: Structural oesophageal dysphagia: Problems predominantly with eating solids or meats. Causes included obstruction by cancer, benign strictures, diverticula or in young people an allergic condition called eosinophilic oesophagitis.

2b: neuromuscular oesophageal dysphagia:

3: oesophageal neuromuscular

If the patient has a food bolus obstruction this is a clinical emergency that can lead to perforation if patient does not have endoscopy within 24 hours.  There patients therefore should be referred to the emergency department for acute assessment. Trials of different muscle relaxants for food bolus have not shown any affect, therefore patients should go straight to endoscopy.

 

 

 

 

5 out of 5 stars
posted 3 months ago

Dr. Van Rijnsoever is an excellent Gastroenterologist and Highly recommended. He was very helpful and provided me all with all the information I needed as well referrals, the procedure and reports for immigration. I would definitely refer anyone to him. 5 STARS!

5 out of 5 stars
posted 4 weeks ago

My son Liam has been under the care of Marius for most of this year with some complex issues which are now resolved. Marius was extremely knowledgeable and professional in his care throughout this process, while offering a kind and empathetic approach to both myself and Liam . I would thoroughly recommend him to anyone seeking the services of a Gastroenterologist.

5 out of 5 stars
posted 5 months ago

Dr Marius was very attentive and responded fully to my description of my state of health (physically and psychologically/emotionally). He was able to provide me with relevant information to assist me in moving forward, and made referrals to ensure that anything needing to be checked could be checked. Matthew Connolly

5 out of 5 stars
posted 3 months ago

I suffer from Eosinophilic esophagitis, & Marius has been the most qualified surgeon that I have ever had doing the procedure of GI endoscopy. He is very informative. About the only person I would trust to do a Endoscopy procedure correctly & safely. I very much recommend, hence 5 stars.

5 out of 5 stars
posted 4 weeks ago

Fantastic, knowledgeable and highly communicative Doctor.