causes, types, risk factors of dysphagia and esophageal cancer

1. DYSPHAGIA
Dr Makanga

2. Definition
• Difficulty in swallowing
• NOT painful swallowing – odynophagia
• Pharyngeal dysphagia vs Esophageal
dysphagia

3. Causes
• Local vs generalized
• Intraluminal vs extraluminal vs intramural
• Benign vs malignant

4. Causes
intraluminal intramural extraluminal
BENIGN Foreign body Stricture (caustic or
inflammatory)
Retrosternal Goitre
Benign polyps and
other tumors
Achalasia Massive cervical
adenopathy
Esophageal webs Thoracis aortic
aneurysm
Achalasia
Pharyngeal pouch
MALIGNANT Ca esophagus

5. Causes
• General causes
– Mysthenia gravis
– Bulbar palsy
– Bulbar poliomyelitis
– Diphtheria
– Systemic sclerosis/ scleroderma

6. Assessment
• Ascertain the presence of dysphagia
• Course of disease may suggest etiology
• Examination to rule in/out systemic causes

7. Investigation
• Endoscopy
• Barium swallow
• Chest X-ray

8. Achalasia cardia

9. Achalasia cardia

10. Benign stricture

11. Reflux stricture

12. Esophageal ring

13. Esophageal lipoma

14. Right heart failure

15. Foreign body

16. Esophageal cancer

17. Management
• Depends on grade and cause of dysphagia
• Grade 4 requires urgent admission and
intervention
• Choice of treatment may depend on
physiologic status of patient

18. Benign stricture
• Dilatation
– Using bougies
– Balloon dilatation

19. Ca esophagus
• Palliative stenting (?level of tumor)
– Endoscopic metal stents
– Pulsion/traction tubes
• Celestine tube
• Mousseau Barbin tube
• Esophagectomy (careful patient selection)

20. Foreign body
• Heimlich maneuver
• Endoscopic removal
• Esophagotomy and removal

21. Achalasia cardia
• Heller’s myotomy

22. Esophageal webs / rings
• Endoscopic electro-incision

23. Thank you