Common Cause Of Dysphagia Research Articles

Esofagitis eosinofílica

Eosinophilic esophagitis is a chronic immune-mediated inflammatory disease of the esophagus. Its incidence has increased in recent years and it is one of the most prevalent esophageal diseases, with a significant impact on physical health and quality of life. Symptoms are variable and it is an increasingly common cause of dysphagia in both children and adults. The gold standard for diagnosis is upper gastrointestinal endoscopy with biopsies of patches demonstrating inflammatory infiltrate with more than 15 eosinophils per high-power field. Various effective treatments are currently available for both induction and maintenance of disease remission, including proton pump inhibitors, swallowed topical corticosteroids, and exclusion diets.

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Eosinophilic esophagitis is a chronic immune-mediated disease whose incidence has been increasing in recent years. It preferentially, but not exclusively, affects men and people with a history of atopy. It is estimated that the current prevalence in developed countries exceeds 100 cases per 100,000 inhabitants. It is the most common cause of dysphagia and food impaction throughout the pediatric age, and has a negative impact on quality of life. It affects boys more than girls. Its first therapeutic step consists of: exclusion diets, proton pump inhibitors and swallowed topical corticosteroids. In refractory cases, dupilumab, a biologic with anti-interleukin 4 and 13 capacity, can be used with very promising results.

Acute respiratory failure in achalasia with megaesophagus

Introduction: Achalasia is one of the most common causes of dysphagia. Typical symptoms include difficulty in swallowing, regurgitation, weight loss, and chest pain. Megaesophagus is a complication of advanced achalasia. This condition rarely causes tracheal compression with acute dyspnea. Case Presentation : A 51 years old man came to the emergency room and had complaints of intermittent shortness of breath accompanied by a cough for 1 week, chest pain that came and went, nausea (+), vomiting (+), difficulty in swallowing food, and fever (-). The medical history showed that the patient went to gastroenterology polyclinic to examine his dysphagia and esophageal sphincter dilatation 2 months ago. The patient received treatment in the ward, but the complaints he suffered was getting worse, so he was transferred to the ICU with a diagnosis of acute respiratory failure. Conclusion: The patient was then intubated and decompressed for the megaoesophagus he suffered with the aim to reduce the compression of the trachea and lungs by the esophagus. The patient was getting better and could be extubated on the 3rd day of treatment.

Corrosive Esophageal Strictures: Alarming News for Gastroenterologists

Dysphagia is a common yet alarming symptom reported by patients during routine visits to outpatient clinics of gastroenterology. Most of them have a chronic history gastroesophageal reflux disease and use of proton pump inhibitors or anti reflux medications for years. The agonising part is that they are not referred by the physicians in the general practice. One of the major reasons behind this is persistent reluctance of patients to go for invasive investigations Gastroesophgeal reflus disease, achalasia ,hiatal hernia,benign esophgeal strictures, barrets esophagus and esophageal carcinoma are common causes of dysphagia. One of the causes which has been quite prevalent in our country is use of corrosives especially young girls and boys who are emotionaland depressed. They do something very outrageous in a moment which becomes a reason for regret for a long time .Corrosive esophgeal strictures isn’t that difficult got gastroenterology experts in normal circumstances but the cases can get complicated rarely including the risk of perforation in early stages of injury. Endoscopic dilatation either by Savory or TTS Balloon has been the cardinal line of management of corrosive strictures. They are done after necessary workup and investigations including barium swallow . The real dilemma is that patent develop complications like tracheoesophageal fistula after repeated dilatations. The length of follow up session are also difficult to determine with some centres opting for one weekly and others for two weekly sessions .Weekly sessions have been reported to ease off symptoms like dyphagia but causes higher risk of complications while in case of two weekly follow up there is enhanced risk of recurrence of symptoms and lesser complications.

Eosinophilic Oesophagitis in Patients Presenting with Dysphagia: A Retrospective Study from a Single Tertiary Care Centre in Saudi Arabia

Background and Study Aims: Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in many Western countries, especially in young adults; however, the prevalence of EoE in Middle Eastern countries remains unknown. We aimed to estimate the prevalence of EoE in Saudi patients presenting with dysphagia. Additionally, we aimed to assess the practice pattern of physicians with respect to evaluating these patients.
 Patients and Methods: We performed aretrospective review of all adolescent and adult patients who underwent upper gastrointestinal endoscopy for the assessment of dysphagia. Demographic data and endoscopic and histologic findings were reviewed. The primary outcome was the prevalence of biopsy proven EoE, defined as 15 or more eosinophils per high power field (≥15eos/hpf) in patients presenting with dysphagia. Secondary outcomes included the frequency of endoscopic features suggestive of EoE and the physician’s judgement about the need for oesophageal biopsies to diagnose EoE.
 Results: A total of138 patients were identified and reviewed. The mean age was 50.7 years; 43.5% were males and 56.5% were female. Endoscopy revealed normal oesophageal mucosa in 52.9% of the patients. White plaques were reported in 4.3%, linear furrows in 2.9% and multiple rings (trachealization) in 2.2% of patients. Oesophageal biopsies were obtained from 20.3% of all patients to rule out EoE, this included 7.1% of those with normal appearance of the oesophageal mucosa. Only two patients (1.4%) with biopsy proven EoE were identified from this cohort; both were young adults.
 Conclusions: Failure to perform oesophageal biopsies in patients presenting with dysphagia as per international guidelines could explainthe low prevalence of EoE observed in this population. Alternatively, the prevalence of EoE may be lower than expected in the Middle Eastern countries. Large prospective studies are necessary to accurately assess the prevalence of EoE in Middle Eastern countries.

Clinical Profile and Upper Gastrointestinal Endoscopic Findings in Patients with Dysphagia and Its Relation to Alarm Symptoms

Dysphagia is derived from the Greek word dys (difficulty, disordered) and phagia (to eat). It refers to the sensation where food is hindered in its passage from the mouth to the stomach. It is of two types – Oropharyngeal and Esophageal. Esophageal dysphagia can be either motor or mechanical. Symptoms vary depending upon the degree of luminal obstruction, associated esophagitis and type of food taken.Study design: prospective cross sectional study . The study took place from November 2021 to December 2022 in Department of Gastroenterology, BSM Medical University, Dhaka Bangladesh with sample size of 125. Patients with dysphagia with or without alarm symptoms attending the outpatient clinic of Gastroenterology department during the period were selected for study. Results show that a total of 125 patients were included in the study, 63 males and 72 females. Majority of patients were seen in the age group of 41 – 60 yrs (43.7 %). Clinically significant weight loss and vomiting was seen in around 22.2 % of the patients. Endoscopy was done in all patients presented with dysphagia. The common cause of dysphagia among the malignant etiology was found to be Ca Oropharynx (12%), followed by Ca Esophagus (4.8%), Ca OG JN (2.4%). Among the benign causes the most common etiology was due to post cricoid web (12.8%), followed by esophageal strictures (12%). Endoscopy was found to be normal in 37 patients (29.6%). Malignant etiology was found to be more common among males. Normal endoscopy was predominant among females. In conclusion, Upper GI Endoscopy is virtually always needed in the evaluation of esophageal dysphagia, allows tissue sampling, and, in many cases, is therapeutic, obviating the need for further evaluation. It is a very effective and appropriate tool to diagnose the causes of dysphagia in both the young and especially the elderly. Alarm symptoms like anorexia, vomiting, wt loss, melena may be more suggestive of malignant cause. Upper GI endoscopy will help in making an early and definite diagnosis.

Application of non-invasive brain stimulation with the use of repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in the treatment of dysphagia following an ischemic stroke – analysis of research reports

Stroke is one of the significant problems and causes of death, in particular in highly developed countries. It is also the most common cause of dysphagia. This study is devoted to the analysis of publications from the last decade concerning research on the use of non-invasive brain stimulation (TMS, tDCS) in the treatment of dysphagia following an ischemic stroke. The following databases were searched for publications: PUBMED, Polish Scientific Journals Database, EBSCO, ScienceDirect. Out of 358 articles found, only two met all the inclusion conditions. The studies discussed in this article included patients who had their first unilateral ischemic stroke, followed by dysphagia. Findings from pilot studies on the effectiveness of the use of tDCS in the treatment of dysphagia following an ischemic stroke were analysed. Fourteen patients aged 50-92 were randomly assigned to two groups. The study group was treated with anodic stimulation, and the control group with sham brain stimulation. The results showed that patients in the study group obtained a statistically significant result, indicating an improvement in the swallowing function as measured by the Dysphagia Score and Severity Scale. The above data may indicate the effectiveness of the use of tDCS in the treatment of dysphagia. Fifty patients were qualified for the research on the effectiveness of rTMS in the treatment of dysphagia. Three groups were created: the first group treated with high frequency rTMS, where patients received rTMS stimulation – 3Hz; the second group with low frequency rTMS – 1Hz; and the control group. The effectiveness of the therapy used was assessed on the fifth day and after 1, 2 and 3 months. After 5 days the groups where active rTMS stimulation was used showed greater improvement in the swallowing function compared to the sham stimulation group. Improved results in the Standardized Swallowing Assessment were also recorded after 3 months in the 1Hz and 3Hz groups, but this did not apply to the control group. In three groups, the results of the water swallow test and the degree of dysphagia improved after 3 months. This analysis shows that non-invasive brain stimulation using tDCS and rTMS in the treatment of dysphagia is associated with improved swallowing function. However, the small number of studies conducted in this area does not allow for extrapolation of their results.

Endoscopic evaluation of dysphagia incorporating eating assessment tool-10 and dysphagia outcome and severity scales-a cross-sectional study

<p><strong>Background</strong>: Dysphagia is associated with significant morbidity and mortality. A careful history may determine the cause of dysphagia in over 80% of patients. The intention of my study is to assess the patients of dysphagia using fiberoptic nasopharyngolaryngoscope and to study their clinicopathological profile and assess the severity using dysphagia outcome and severity scale (DOSS) scale and eating assessment tool (EAT)-10 score.</p><p><strong>Methods</strong>: A descriptive cross-sectional study of patients with symptoms of dysphagia who presented to the ENT department were included. The study was conducted from January 2018 to June 2019. A total of 120 patients were taken for the study.</p><p><strong>Results:</strong> Dysphagia was more common among males than females and more prevalent in the age group of 61-70 years. Patients with tracheostomy had an EAT-10 score above 6 and DOSS level 5 and below. EAT-10 score was helpful to assess dysphagia with the majority of patients having a score of 6 to 10 and the scores correlated with DOSS levels. Indirect laryngoscopy (IDL) was helpful to diagnose in 68.5% of cases and fibre optic laryngoscopy (FOL) was helpful in diagnosis in 75.8% of cases. Malignancy was the most common cause of dysphagia (25%) followed by laryngopharyngeal reflux (24.2%). Mortality rate in the present study was 15 %</p><p><strong>Conclusions:</strong> Dysphagia is a complex symptom, the description of which varies from person to person and is common among the elderly population and in those with co-morbidities and needs to be evaluated early to diagnose and treat the underlying cause.</p>

Botulinum toxin A injection using ultrasound combined with balloon guidance for the treatment of cricopharyngeal dysphagia: analysis of 21 cases

Background As an upper oesophageal sphincter (UES) dysfunction disorder, cricopharyngeal achalasia (CPA) is a common cause of dysphagia and is associated with an increased risk of pulmonary complications. The aim of this study was to investigate the effectiveness and safety of BTX-A injection using ultrasound combined with balloon guidance for the treatment of CPA caused by stroke. Methods A total of 21 patients diagnosed with CPA were treated with BTX-A injection into the cricopharyngeal muscle using ultrasound combined with balloon guidance. Primary outcome measures, including the functional oral intake scale (FOIS), videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS), which are quantitative measures for a video fluoroscopic swallowing study (VFSS), and scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed from baseline to 12 weeks after treatment. Repeated measures analysis of variance was used to compare the scores between time points. Results BTX-A injection led to improved dysphagia symptoms and scores in 19 patients (90.48%). Among them, 5 cases were cured (23.81%), 11 cases showed significant improvement (52.38%), and 3 cases showed improvement (14.29%). Two cases were absolutely ineffective (9.52%). Compared with the scores prior to treatment, the scores on the FOIS, VDS, PAS, SAS and SDS significantly improved beginning at 3 days (p < .05) and lasting for at least 12 weeks after injection. Conclusions Ultrasound with balloon-guided BTX-A injection is probably a relatively safe, easy, and effective technique for the treatment of CPA caused by stroke, with better visualization of the injection procedure. A well-designed controlled trial with a larger sample size is needed for more convincing conclusions.

A133 EVALUATION OF DYSPHAGIA IN AN ACADEMIC CENTRE

BackgroundDysphagia is a common referral to gastroenterology with both benign and malignant etiologies. There is a lack of studies regarding its clinical assessment, complications and outcomes in Canada.AimsTo evaluate the assessment and outcomes of secondary and tertiary level dysphagia referrals in adult patients.MethodsWe conducted a retrospective analysis of 98 consecutive adult patients who were initially referred for dysphagia to the Division of Gastroenterology at the Kingston Health Sciences Centre in 2015. Chart reviews were performed to assess demographics, characteristics of dysphagia, time for clinical assessment and outcomes.ResultsOf the referred patients, 19 did not present for their clinic appointment. The majority of patients (60%) were >60 yrs old with an equal distribution of male and female patients. In the assessed patients, reflux was the most common etiology (55.5%) followed by oropharyngeal causes (13.5%) and motility disorders (12%). Only 3 patients of the cohort were diagnosed with esophageal cancer, 2 of whom had metastasis at the time of presentation. Time from referral to clinical assessment was <4 weeks in just 30% and >12 weeks in 55%. For the patients diagnosed with malignancy, 2 were assessed within of 2 weeks while the third patient was assessed and endoscoped at 12 weeks. In patients sent for endoscopy, 28% had an endoscopy <4 weeks after assessment while 47% had endoscopy > 12 weeks after assessment. Manometry was performed in 18% of the patients assessed. Information was available on the course of the dysphagia in 65 patients. Dysphagia had resolved or improved in 83%, remained unchanged in 14% and worsened in 3%.ConclusionsReflux-related dysphagia was by far the most common cause of dysphagia in this referral cohort. Wait times for clinical assessment greatly exceeded current CAG recommendations in the majority. Given current resource constraints, this highlights the need for improved referral information and patient care pathways in the management of patients referred with dysphagia.Funding AgenciesNone

Predictors of Aspiration Pneumonia and Mortality in Patients with Dysphagia.

To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center. Historical cohort study. All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained. 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR]=2.36, 95% confidence interval [CI]: 1.33-4.19), hypertension (OR=1.82, 95% CI: 1.23-2.73), tracheotomy status (OR=2.96, 95% CI: 1.09-7.99), and vallecular residue (OR=1.88, 95% CI: 1.24-2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR=1.27, 95% CI: 1.02-9.9), COPD (OR=3.27, 95% CI: 1.65-6.49), vallecular residue (OR=2.35, 95% CI: 1.35-4.1), male gender (OR=2.21, 95% CI: 1.25-3.92), and low body mass index (OR: 1.12, 95% CI: 1.06-1.19) were independent adjusted risk factors for death. The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR=3.0), COPD (OR=2.4) and vallecular residue (OR=1.9). The greatest adjusted risk factors for death were COPD (OR=3.3), vallecular residue (OR=2.3), and male gender (OR=2.2). 4 Laryngoscope, 132:1172-1176, 2022.

S2087 Endoscopic Cap-Assisted Retrieval of a Fishbone in the Esophagus

INTRODUCTION: Foreign body ingestion is a common cause of dysphagia and odynophagia. Common presenting symptoms can include dysphagia and odynophagia as previously mentioned, as well as chest pain/pressure, globus sensation, nausea, vomiting, or neck pain. While the majority of foreign bodies will pass spontaneously, a subset can become stuck and require retrieval. Cap-assisted endoscopic retrieval can aid in removal of the foreign body. We present a case of a patient who presented with odynophagia and globus sensation found to have a fishbone in his esophagus after eating fish for dinner. CASE DESCRIPTION/METHODS: The patient is a 62 year old male without significant past medical history who presented to the emergency department with odynophagia and a globus sensation. He was eating fish for dinner and felt as though a piece became stuck in his throat and presented to the ED for evaluation. CT scan of the neck showed a fishbone horizontally stuck in the esophagus at the level of C6 with penetration of the esophageal wall and extraluminal air. The patient went for upper endoscopy where a 2.5 cm fishbone was found in the proximal esophagus, lodged into both walls. A transparent cap was employed during the endoscopic retrieval. The foreign body was then removed with a Raptor grasping device and hemostatic clips were places along the perforated esophageal edges to repair the tear. He subsequently had a barium esophagram, which showed no esophageal leak. His diet was advanced successfully and he was discharged on a 7-day course of augmentin. DISCUSSION: Obtaining a reliable patient history is paramount in determining the correct diagnosis. If the clinical history prompts a high degree of suspicion, obtaining CT scan is the preferred imaging modality. Once the presence of a foreign body is confirmed on imaging, it can be retrieved via endoscopy. Utilizing endoscopic caps can aid in the visualization and retrieval of foreign bodies in the gastrointestinal tract. As seen with our patient, his clinical history created a high suspicion, prompting CT scan, which confirmed the presence of a fishbone lodged in the esophagus. The foreign body was retrieved via upper endoscopy the following morning with improvement in symptoms. His course was notable for esophageal wall penetration, which was successfully repaired endoscopically.Figure 1.: Foreign body in the esophagus with a clear cap in view.

Sa1260 ADDITION OF DISRUPTION TO BOUGIE DILATION OF ESOPHAGEAL RINGS AND STRICTURES PROLONGS TIME TO REPEAT INTERVENTION COMPARED TO DILATION ALONE

Esophageal rings and strictures are a common cause of dysphagia. Endoscopic dilation, forceps disruption, or a combination are often employed to alleviate symptoms. Although rings have been reported to require fewer repeat dilations and increased time to repeat dilation, the clinical impact of mode of dilation remains unclear. We aimed to determine whether disruption at time of dilation would increase time to subsequent intervention. We performed a retrospective analysis of all adult patients who underwent esophageal disruption and/or dilation of a ring or stricture in 2015 at a tertiary care center. Individuals were excluded if they had had prior radiofrequency ablation, endoscopic mucosal resection, achalasia, any malignancy, history of chemotherapy or radiation, or prior foregut surgeries. From the electronic medical record, we extracted age, BMI, gender, time to next dilation, type of dilator, size of dilation, and use of anti-secretory medications. Rings or strictures were defined based on the descriptor used in the endoscopic record. Data was analyzed utilizing Fischer’s Exact Test for categorical data, Mann-Whitney for continuous variables, and Kaplan-Meier to compare time to repeat dilation. Of 548 patients, 195 met inclusion criteria (age 60.9±0.9, BMI 28.0±0.5, 66% female). Age, BMI, and gender did not influence need for repeat dilation (p=ns for each). Balloon dilation (78%) was used more often than bougie dilation (19%) or forceps disruption alone (4.1%). Antisecretory medication use with dilation compared to no use (81% vs 19%) did not reduce need for repeat dilation (52.2% vs 50.0%, 0.8) or shorten time to repeat dilation (503 vs 404 days, p=0.8). Rings were more likely than strictures (33% vs. 66%) to be disrupted with forceps prior to dilation (45.5% vs 21.7%, p=0.001) and to a larger dilation size (18.7 mm vs 17.6 mm, p=0.009).When forceps disruption was performed with dilation (29.7%), time to repeat dilation was numerically longer (504.9 vs 477.04 days, p=0.4) with similar need for repeat dilation (47% vs. 54%, p=0.3). There was no significant difference in time to repeat dilation (568.5 vs 447.3 days, p=0.2) or need for repeat dilation (47% vs 54%, p=0.3) between rings and strictures, with or without forceps disruption. When analyzing mode of dilation, patients managed with bougie dilation had significantly prolonged time to repeat dilation when forceps disruption was also performed compared to bougie dilation alone (851±248 vs. 237±76 days respectively, p=0.01), similar findings were not seen with balloon dilation (404.33 vs. 542.21, respectively p=0.3). These findings were supported by Kaplan Meier hazard analysis (Figure). Stricture or ring disruption with bougie dilation significantly prolongs time to repeat dilation, although this trend was not found with balloon dilation.

STUDY OF ENDOSCOPIC DIAGNOSIS OUTCOMES IN PATIENTS SUFFERED FROM DYSPHAGIA

Swallowing problems (dysphagia) can occur at any point in the process of moving food, liquid, or saliva from the mouth through the throat (pharynx), into the esophagus and to the stomach. These problems may result in poor nutrition, dehydration or aspiration (accidental ingestion of food particles or fluids into the lungs). Dysphagia reduces quality of life. Swallowing disorders are often accompanied by voice impairment (dysphonia) as well. The central goal of the Clinic is to provide comprehensive evaluation and management of dysphagia and related disorders and improve quality of life. Hence based on above findings the present study was planned for Study of Endoscopic Diagnosis Outcomes in Patients Suffered from Dysphagia.&#x0D; The present study was planned in Department of General surgery, Government Doon Medical College, Dehradun, Uttarakhand, India. The study was conducted from January 2017 to October 2017. In the Present study 50 cases diagnosed with the dysphagia were enrolled and evaluated. The diagnosis was confirmed by biopsy taken during endoscopy and sent for histopathological examination. Patients were treated accordingly.&#x0D; The data generated from present study concludes that Squamous cell carcinoma of oesophagus was found to be the most common cause of dysphagia which can be due to rising incidence of gastro esophageal reflux disease or Barret’s esophageous. Hence role of endoscopy is much valuable in detecting these premalignant conditions to prevent this manifestation.&#x0D; Keywords: Dysphagia, Endoscopy, Carcinoma esophagus, etc.

Study on the association between eosinophilic esophagitis and bronchial asthma in Egyptian patients with esophageal symptoms

Introduction Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus in which eosinophils play a major role in its pathogenesis and is presented clinically by esophageal dysfunction. EoE represents the second most common cause of chronic esophageal disease after gastroesophageal reflux disease (GERD) and is considered the most common cause of dysphagia in both adults and children. Asthma is a well-known chronic inflammatory disorder of the airways that involves several inflammatory cells including eosinophils. Multiple inflammatory mediators developed the characteristic pathophysiological changes that resulted in airway obstruction and appearance of symptoms of cough and breathlessness. This study aimed to study the incidence of EoE in Egyptian patients with bronchial asthma and address the patient’s characters and risk factors that increases the association. Settings and design This study was carried out on Egyptian asthmatic patients with esophageal symptoms. From 200 asthmatic patients, only 89 patients had esophageal symptoms (heartburn, regurgitation, or dysphagia) and were prepared for endoscopy. Patients and methods Upper gastrointestinal tract endoscopy was performed on all 89 cases and the findings were reported. Esophageal biopsy was taken from all cases and examined histopathologically for EoE criteria. Results The results showed that about 11% of asthmatic patients who suffered from GERD symptoms had associated EoE confirmed by esophageal biopsy and histologic findings. The incidence of EoE was increased in atopic asthmatic patients who had high immunoglobulin E. Conclusion Asthmatic patients who suffered from GERD symptoms should be assessed for EoE by endoscopic and histopathological examination.

Endoscopic evaluation of dysphagia

Background: Dysphagia basically means difficulty in swallowing. Dysphagia may result from structural or neuromuscular disorders of the esophagus. Endoscopy is the main indication for patients with dysphagia to determine the underlying etiology. The main objective of the study was to evaluate the plethora of disorders leading to dysphagia in this region of Punjab.Methods: The present study was carried out in the department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences And Research, Sri Amritsar. Gastrointestinal endoscopy was performed both on the patients admitted and those who presented at outpatient department. The diagnosis was confirmed by biopsy.Results: The sample consisted of 100 patients presenting with dysphagia. Total number of males were 42% and 58% females. It was found that the most common age group presenting with dysphagia was 41-60 years followed by 61-80 years. It was also observed that the most common cause of dysphagia was growth of esophagus (24%). Lower esophagus was most common site of lesion found in 30 (45%) of the patients. Squamous cell carcinoma was found in 52 (24%) of the patients. Maximum patients (84%) were of lower socioeconomic status. Dysphagia was more common in females as compared to males.Conclusions: It can be concluded that prevalence of dysphagia in Indian settings is more in the middle to the elderly age group with a female preponderance. Endoscopy plays an important role in detecting premalignant conditions leading to dysphagia.

Upper gastrointestinal endoscopy in patients with dysphagia: our experience

Background: One of the common indications for upper gastrointestinal (GI) endoscopy is dysphagia. Dysphagia is usually associated with serious underlying disorder that requires immediate attention. The current study aimed to determine the frequency of common endoscopic findings in patients presenting with dysphagia.Methods: This retrospective study was conducted at the S.S Institute of Medical Science and Research center Davangere from January 2015 to June 2019. Patients admitted with complaints of dysphagia, OPD patients and references with complaints of dysphagia underwent upper GI endoscope by different endoscopist were included in the study. Register in endoscopic room was referred for different endoscopic findings in dysphagia patients.Results: A total of 158 patients presenting with dysphagia were studied, 83 (52.53%) were males and 74 (47.46%) were females. The mean age was 55years. Normal study present in 63 (39.87). Malignant oesophageal stricture was the next common finding noted in 47 (29.74%) patients. Among these patients 25 (53.19%) males and 22 (46.80%) females patients. It was followed by reflux esophagitis in 31 (19.62%) patients. Benign oesophageal strictures in 9 (5.69%) patients while achalasia was noted in 1 (0.63%) patients, 7 (4.46%) patients had findings other than the ones mentioned above. Malignant lesions commonly present in elderly patients with age. Benign lesions present commonly in younger age group.Conclusions: Malignancies, reflux esophagitis, benign oesophageal strictures are a more common cause of dysphagia in our population. Early diagnosis of can result in proper treatment of many of these cases.

457 Predictor Factors for Dilation Treatment in Stricture Due to Eosinophilic Esophagitis

INTRODUCTION: Eosinophilic esophagitis (EOE) is one of the most common causes of dysphagia and food impaction in the last two decades. Medical therapy including proton pump inhibitors (PPI), topical steroids, and diet can help, but if an esophageal stricture is present, then dilation may be necessary. The safety and efficacy of stricture dilation in EOE have been shown, but there is limited data on factors that can predict if patients will require multiple dilations. The objectives of this study were to determine the frequency and predictors of requiring multiple dilations in patients with EOE. METHODS: A retrospective study from 2003-2018 was performed at a tertiary care center. Patients included in this study required a pathologic diagnosis of EOE (&gt;15 eosinophils per high power field), and required an esophageal stricture. The response was defined as the absence of symptoms. Adverse events included perforation. RESULTS: A total of 34 patients (21 men, 13 women) were included in the study. The median age was 43 years (range, 18-65). Follow-up time was 5.8 years. All patients underwent either a Savary dilation or pressure balloon dilation. Table 1 lists the characteristics of the strictures and balloon dilations. 8 patients required only one dilation session with 100% response rate, which defined. All patients were on PPI. 9 patients did not have adjunctive therapy, while 21 patients used topical steroids, 3 patients used 6-food elimination diet, and 1 patient used both topical steroids and 6-food elimination diet. 5 patients had an 8 mm stricture that was not able to be traversed with the endoscope, requiring a median of 2 sessions (range 2, 3) of dilation. Table 2 shows the characteristics of the strictures stratified by the number of sessions. Table 3 shows the number of sessions stratified by the length of the stricture. There were no perforations. CONCLUSION: Esophageal dilation has a definitive role in the management of EoE. It is indicated if the patients do not respond to pharmacological or dietary therapy. In this study, it seems the major predictor factor for frequent esophageal dilation is the length of the stricture. The treatment including corticosteroid inhaler or 6-food elimination is not helpful when the length of stricture more than 1 cm.

Training Curriculum for the Certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, including FEES", of the German Society for Phoniatrics and Pedaudiology and the German Society for Otolaryngology, Head and Neck Surgery

In Germany, about 5 million people of all ages suffer from dysphagia. Due to demographic change and improved medical care, the incidence of swallowing disorders is expected to increase. Dysphagia is associated with an increased morbidity and mortality and leads to a considerable financial burden on the health systems. The two most common causes of dysphagia are neurological disorders and head and neck cancer. Diagnostics and therapy have developed continuously over the past decades. In particular, the flexible endoscopic evaluation of swallowing (FEES) has become an established part of dysphagia diagnostics. The certificate "Diagnostics and Therapy of Oropharyngeal Dysphagia, incl. FEES" was developed by the German Society for Phoniatrics and Pedaudiology (DGPP) and the German Society for Otolaryngology, Head and Neck Surgery (DGHNO KHC) in cooperation with the German Professional Association for Phoniatrics and Pedaudiology and the German Professional Association of Otolaryngologists.It consists of three parts: the modules (A, B and C), the indirect supervision and a practical examination. Structure, detailed contents and requirements for obtaining the certificate are described in the following article. The qualification of the lecturers and auditors are also defined. The systematic training serves the quality assurance and establishment of standards in the diagnostics and therapy of oropharyngeal dysphagia in the area of phoniatrics and ear, nose and throat medicine.

Dysphagia in cervical spine diseases

Dysphagia is acommon symptom and can be indicative of avariety of heterogeneous diseases. "Classical" diseases of the head and neck region, such as acute tonsillitis, peritonsillar abscesses, diverticula, and benign or malignant tumors are common causes of dysphagia. However, it can also occur in the context of neurological diseases, e.g., as aresult of stroke or as an age-related phenomenon (presbyphagia). Pathologies of the cervical spine can also be acause of dysphagia. In this context, congenital or acquired diseases, inflammatory or degenerative processes, cervical spine surgery, and (malignant) masses of the cervical spine should be taken into account. Particular dysphagia with apositive history of previous operative interventions on the cervical spine or symptoms such as chronic back pain and trauma should give rise to consideration of a cervical spine-related cause.