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Dysphagia, A Simple Guide To The Condition, Treatment And Related Conditions
Par Kenneth Kee
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114 pages
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Description
Dysphagia is defined as difficulty in swallowing.
It is usually associated either with pharyngeal or esophageal disease
There is a spectrum of possible etiologies from self-limiting illness e.g. tonsillitis to carcinoma.
It may occur with odynophagia - painful swallowing.
It occurs in 1-2/100,000, most commonly seen in mid-adult life and is caused by impaired neural control of the distal esophagus.
Several conditions can cause dysphagia.
In children it is often due to:
1. Physical malformations,
2. Conditions such as cerebral palsy or muscular dystrophy
3. Gastroesophageal reflux disease (GERD).
Dysphagia in adults may be due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, stroke, or GERD.
It can also be caused when the muscle in the esophagus does not relax enough to let food pass into the stomach.
Other risk factors include smoking, excessive alcohol use, certain medications and teeth or dentures in poor condition.
A. Obstructive causes:
1. Gastro-oesophageal reflux ± stricture.
2. Other esophagitis (e.g. infection).
3. Esophageal cancer.
4. Gastric cancer.
5. Pharyngeal cancer.
6. Post-cricoid web (Paterson Brown-Kelly syndrome).
7. Esophageal rings.
8. Foreign body (acute).
B. Neurological Causes
1. Cerebrovascular event or brain injury.
2. Achalasia.
3. Diffuse esophageal spasm.
4. Syringomyelia or bulbar palsy.
5. Myasthenia gravis.
6. Multiple sclerosis.
7. Motor neurone disease.
8. Myopathy (dermatomyositis, myotonic dystrophy).
9. Parkinson's disease and other degenerative disorders.
10. Chagas' disease.
Steady worsening of dysphagia over a few weeks in an older patient suggests malignancy.
Men with new onset of alarm symptoms (loss of weight with worsening dysphagia) have an increased likelihood of a diagnosis of cancer, especially in those aged over 65
A positive predictive value of 9.0% has been found in this age group.
The most common lesions within the esophagus are inflammatory strictures from reflux or tumors.
In esophageal manometry, a tube is inserted into the stomach to measure pressure differences in various regions.
X-rays of the neck, chest, or abdomen may be taken.
Barium swallow and endoscopy with biopsy should be performed.
In a barium x-ray, moving picture or video x-rays are taken of the esophagus as you swallow barium, which is visible on an x-ray.
MRI scanning may also be required before any surgery is considered, e.g. if there is esophageal carcinoma.
Videofluoroscopy is the radiological investigation of choice when 'difficulty swallowing' rather than 'food sticking' is the presenting symptom and aspiration is suspected.
Esophageal motility studies (require swallowing a catheter containing a pressure transducer) are useful when esophageal spasm is suspected.
The patient may need to chew well or liquidize food.
Definitive treatment depends on cause - usually endoscopic dilation (either using bougies or inflatable balloon).
In esophageal carcinoma, palliative relief of dysphagia can be achieved with repeated dilatation, stent replacement, laser photocoagulation and injection of sclerosants.
Surgical myotomy and endoscopic injection of the sphincter with botulinum toxin is occasionally used
TABLE OF CONTENT
Introduction
Chapter 1 Dysphagia
Chapter 2 Interesting Facts of Dysphagia
Chapter 3 Treatment of Dysphagia
Chapter 4 Stroke
Chapter 5 Parkinson's Disease
Chapter 6 GERD
Chapter 7 Tonsillitis
Epilogue
À propos de l'auteur
Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 70.However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"
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Dysphagia, A Simple Guide To The Condition, Treatment And Related Conditions - Kenneth Kee
Dysphagia,
A
Simple
Guide
To
The Condition,
Treatment
And
Related Conditions
By
Dr Kenneth Kee
M.B.,B.S. (Singapore)
Ph.D (Healthcare Administration)
Copyright Kenneth Kee 2014 Smashwords Edition
Published By Kenneth Kee at Smashwords.com
Dedication
This book is dedicated
To my wife Dorothy
And my children
Carolyn, Grace
And Kelvin
This book describes the disease Dysphagia and Its Treatments and Related Diseases or in vernacular terms
(What You Need to treat Dysphagia)
This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.
If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.
Thank you for respecting the hard work of this author.
Introduction
Ode to Dysphagia
Dysphagia is defined as difficulty in swallowing
There may be vomiting, coughing and choking
Causes may from inflammation, e.g. tonsillitis, laryngitis
Other causes are Gastroesophageal reflux disease and esophagitis
Tumors and strictures may also be causing obstruction
Irritants are smoking, excessive alcohol, certain medications
There are neurological causes such as myasthenia gravis
Muscular causes such as muscle dystrophy and multiple sclerosis
Eosphageal symptoms include pain on swallowing,
Sensation of food stuck in the chest and belching.
Oropharyngeal symptoms are difficulty trying to swallow,
Chest pain, coughing, regurgitation as well as vomiting also
Definitive treatment depends on cause - usually endoscopic dilation
Palliative relief of dysphagia can be achieved with stent replacement
Diverticuli of the pharynx and esophagus can be treated endoscopically.
Eosphageal tumors or strictures can be removed surgically
-An original poem by Kenneth Kee
Interesting Tips about the Dysphagia
A Healthy Lifestyle
1. Take a well Balanced Diet
2. If cancer is a possibility - all cases need urgent assessment under the 'two-week rules'
a. General
The patient may need to chew well or liquidize food.
There is insufficient evidence currently to support the efficacy of dietary modification, swallowing maneuvers, surgical interventions or enteral feeding for the treatment of chronic neuromuscular conditions
Neurological problems, e.g. cerebrovascular event, may be helped by involving a speech therapist
b. Surgical
Definitive treatment depends on cause - usually endoscopic dilation (either using bougies or inflatable balloon).
In esophageal carcinoma, palliative relief of dysphagia can be achieved with repeated dilatation, stent replacement, laser photocoagulation and injection of sclerosants.
Surgical myotomy and endoscopic injection of the sphincter with botulinum toxin is occasionally used for some etiologies.
3. Keep bones and body strong
Bone marrow produces our blood
Eat foods rich in calcium like yogurt, cheese, milk, and dark green vegetables.
Eat foods rich in Vitamin D, like eggs, fatty fish, cereal, and fortified milk.
Eat food rich in Vitamins B and C such as green vegetables and fruits
Zinc and other minerals are important to the body
4. Get enough rest and Sleep
Avoid stress and tension
5. Exercise and stay active.
It is best to do weight-bearing exercise such as walking, jogging, stair climbing, dancing, or lifting weights for 2½ hours a week.
One way to do this is to be active 30 minutes a day at least 5 days a week.
Begin slowly especially if a person has not been active.
6. Do not drink more than 2 alcohol drinks a day for a man or 1 alcohol drink a day for a woman.
Alcohol use also increases the chance of falling and breaking a bone.
Alcohol can affect the neurons and brain cells.
7. Stop or do not begin smoking.
It also interferes with blood supply and healing.
Chapter 1
Dysphagia
What is Dysphagia?
Dysphagia is defined as difficulty in swallowing.
It is usually associated either with pharyngeal or esophageal disease
There is a spectrum of possible etiologies from self-limiting illness e.g. tonsillitis to carcinoma.
It may occur with odynophagia - painful swallowing.
It occurs in 1-2/100,000, most commonly seen in mid-adult life and is caused by impaired neural control of the distal esophagus.
What are the causes of Dysphagia?
Causes:
Several conditions can cause dysphagia.
In children it is often due to:
1. Physical malformations,
2. Conditions such as cerebral palsy or muscular dystrophy
3. Gastroesophageal reflux disease (GERD).
Dysphagia in adults may be due to tumors (benign or cancerous), conditions that cause the esophagus to narrow, neuromuscular conditions, stroke, or GERD.
It can also be caused when the muscle in the esophagus does not relax enough to let food pass into the stomach.
Other risk factors include smoking, excessive alcohol use, certain medications and teeth or dentures in poor condition.
A. Obstructive causes:
1. Gastro-oesophageal reflux ± stricture.
2. Other esophagitis (e.g. infection).
3. Esophageal cancer.
4. Gastric cancer.
5. Pharyngeal cancer.
6. Post-cricoid web (Paterson Brown-Kelly syndrome).
7. Esophageal rings.
8. Foreign body (acute).
B. Neurological Causes
1. Cerebrovascular event or brain injury.
2. Achalasia.
3. Diffuse esophageal spasm.
4. Syringomyelia or bulbar palsy.
5. Myasthenia gravis.
6. Multiple sclerosis.
7. Motor neurone disease.
8. Myopathy (dermatomyositis,
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- (5/5)Excellent book for a non-medical person, loaded with the stuff you need to know!