Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What are the other causes of dysphagia for solid food?
The most common causes of dysphagia for solid food are
esophageal strictures and Schatzki (lower esophageal) rings. Esophageal
strictures are narrowings of the esophagus that result from inflammation and
scarring, most commonly from chronic
acid reflux. Strictures usually are located in the lower esophagus near the
entrance of the esophagus into the stomach where the acid reflux is most severe. Schatzki rings are
thin webs of tissue of unclear cause that can narrow the lumen (center) of the
esophagus through which food passes. They also are located in the lower
esophagus. A less common cause of dysphagia for solid food is esophageal cancer
that narrows the esophageal lumen. A still less common cause of dysphagia is
disorders of the muscles of the esophagus. For example,
achalasia,
a disease of the nerves and the muscles of the esophagus that prevents the
muscle at the lower end of the esophagus (the lower esophageal sphincter) from
relaxing and allowing swallowed food to pass into the stomach. Unlike the other
causes of motility disorders, achalasia usually results in problems with swallowing both solid
and liquid food.
How is eosinophilic esophagitis diagnosed?
The diagnosis of eosinophilic esophagitis is suspected whenever dysphagia for
solid food occurs, even though it is not one of the most common causes of
dysphagia. Dysphagia almost always is evaluated by endoscopy
(esophagogastroduodenoscopy or EGD) in order to determine its cause. During the EGD, a
flexible viewing tube or endoscope is inserted through the mouth and into the
esophagus. It allows the doctor to see the inner lining of the esophagus (as
well as the stomach and duodenum). Cancers, esophageal strictures, Schatzki
rings, and usually achalasia, all can be diagnosed visually at the time of EGD.
The doctor performing the EGD also may see abnormalities that suggest
eosinophilic esophagitis. For example, some patients with eosinophilic
esophagitis have narrowing of most of the esophagus. Others have a series of
rings along the entire length of the esophagus. Still others have furrows
running up and down the esophagus and a few have small white spots on the
esophageal lining which represent pus made up of dying mounds of eosinophils. The diagnosis of eosinophilic
esophagitis is established with a biopsy of the inner
lining of the esophagus. The biopsy is performed by inserting a long thin biopsy
forceps through a
channel in the endoscope that pinches off a small sample of tissue from the
inner lining of the esophagus. A pathologist
then can examine the biopsied tissue under the microscope to look for eosinophils.
In many patients with eosinophilic esophagitis, however, the esophagus looks
normal or will show only minor abnormalities. Unless biopsies are taken of a
normal-appearing esophagus, the diagnosis of eosinophilic esophagitis can be
missed. In fact, not taking biopsies has resulted in some patients having dysphagia
for years before the diagnosis of eosinophilic esophagitis is made, and
doctors are now more likely to perform biopsies of the esophagus in individuals
with dysphagia--even those with a normal-appearing esophagus--who have no clear cause for their
dysphagia.
The incidence of eosinophilic esophagitis is on
the rise in the U. S. This rise in incidence may reflect either increased awareness
of the disease among the doctors treating patients with dysphagia or an actual
increase in the prevalence
of this disease.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
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