5: Difficulty swallowing




Investigations (Algorithm 5.1)



  • Videofluoroscopy
  • Microlaryngoscopy if upper airway problems suspected
  • Barium radiology: for stricture, compression, H-type tracheo-oesophageal fistula or achalasia
  • Oesophageal manometry
  • Flexible gastro-oesophagoscopy, with biopsies (multiple oesophageal levels)





Algorithm 5.1 Assessment and management of swallowing difficulties


c5-fig-5001





Management



Ingested foreign bodies



  • Batteries lodged in the oesophagus cause caustic burn and perforation within hours, especially with nickel/cadmium, and should be urgently removed by endoscopy. Batteries that remain in the stomach require retrieval
  • Most other objects, even if sharp, pass harmlessly through the gut. Removal can cause oesophageal trauma
  • Occasionally, a foreign body becomes impacted at the ligament of Trietz or the ileo-caecal valve and causes obstruction
  • Very rarely, an impacted foreign body lodged in the oesophagus erodes into other mediastinal structures. If suspected, surgical referral is required

Tags: ,
May 31, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on 5: Difficulty swallowing

Full access? Get Clinical Tree
Get Clinical Tree app for offline access