Dysphagia (difficulty swallowing) can be a very distressing symptom, particularly if the food gets stuck in the oesophagus for any period of time.The underlying cause is often a narrowing of the oesophagus due to such things as:
- Oesophageal ring (Schatski ring)
- Reflux stricture (Peptic ring)
- Radiation stricture
- Eosinophilic oesophagitis
- Oesophageal Web
It may also be due to a disorder of oesophageal muscle function, called a Motility disorder.
Investigation with Gastroscopy plus:
- Oesophageal dilation with a balloon under direct vision, or with gradually enlarging flexible dilator tubes (Savary dilators), which are inserted over a guide wire.
- Oesophageal biopsies
Referral for Barium Swallow and/or Oesophageal manometry if a motility disorder is suspected.
30 year old man with a long history of difficulty swallowing. He would regurgitate bits of food multiple times per week and was finding the problem increasingly distressing and debilitating. At one stage overseas he had been told it was all in his head.
At endoscopy we found a tight distal oesophageal stricture which was dilated to 20mm using Savary dilators over a guide wire. Biopsies from the oesophagus subsequently showed underlying eosinophilic oesophagitis and he was treated with swallowed flixotide and referred to an immunologist for food allergy advice. He required oesophageal dilation on one further occasion and has had no swallowing issues since.
50 year old woman with food getting stuck once per week on a background of frequent reflux for many years.
Endoscopy showed reflux ulceration extending for 3cm at the bottom of the oesophagus with scarring causing a peptic ring not much more than 10mm diameter (normal =20mm+). Balloon dilation performed on two occasions to get back to 20mm and treated with acid lowering medications and lifestyle modifications to prevent recurrence.