Empiric Dilation in Patients With Unexplained Dysphagia

Abstract

Introduction: Patients with subjective dysphagia with normal findings on both the High Resolution Manometry (HRM) and Esophagogastroduodenoscopy (EGD) represent a challenging cohort to treat. There is a paucity of data on efficacy and safety of the empirical dilation in patients with unexplained dysphagia. The aim of our study is to determine the efficacy and safety of esophageal dilation as empiric therapy for patients with cryptogenic dysphagia.FigureMethods: This is a retrospective cohort study that included patients who met the criteria for unexplained dysphagia, i.e. underlying cause of the dysphagia cannot be determined both on the HRM and EGD between April 2015 and August 2016. Each patient received esophageal dilation with bougie dilators. Post dilation, patients were contacted by telephone and asked about their symptom severity and symptom frequency using the Brief Esophageal Dysphagia Questionnaire* and overall treatment satisfaction (measured on a scale of 1 to 10: 1 being not pleased with current symptoms, 10 being very satisfied. Results: Twenty seven patients (seven male/ twenty female) with dysphagia were dilated with esophageal dilators with a goal of 18mm. Using a questionnaire post dilation, seventeen patients (62.96%%) had improvement of their dysphagia symptoms (i.e. total dysphagia score <3). Seven patients (25.9%) reported symptoms of food stuck in the esophagus for more than 30 minutes; none of the empirically dilated patients had an emergency visit for globus or dysphagia. Conclusion: Empirical esophageal dilation is safe and effective in improving the symptoms of dysphagia in patients without obvious structural lesions or functional disorders. Empirical dilation may improve dysphagia symptoms because subtle structural lesions such as small strictures, webs, rings capable of decreasing the esophageal lumen diameter might go unnoticed on endoscopy. These subtle structural lesions are countered by the empirical esophageal dilation, eventually improve symptoms of dysphagia.