Management of Benign Esophageal Dysphagia

Abstract

Dysphagia is considered to be an alarm symptom, indicating the need for an immediate evaluation to define the exact cause and initiate appropriate therapy. Dysphagia is a serious symptom and it can be caused by malignant process such as esophageal cancer or compression of the esophagus, neurological and motility disorders such as achalasia, or benign disorders like strictures, diverticulae or esophagitis. However, seldom dysphagia is caused by a benign polyp, which protrudes in the esophagus.Benign tumors of the esophagus account for 20% of the esophageal lesions. 60-80% of the lesions are leiomyomas, typically occurring as intramural lesions in the middle and lower esophagus. Dysphagia is the sensation of food being hindered during the passage from the mouth through the esophagus and into the stomach. Dysphagia is traditinally classified as oropharyngeal or esophageal dysphagia. Oropharyngeal dysphagia is the inability to initiate a swallow or inability to transfer food from the mouth to the upper esophagus whereas esophageal dysphagia is the impedance of food passage through the tubular esophagus once the food has successfully passed into the proximal esophagus. A variety of mechanical and neuromuscular disorders can impede the passage of the food bolus through the esophagus. Patients who have an inflammatory process may have associated odynophagia. Most patients often report food ‘‘hanging up’’ or ‘‘sticking’’ behind the sternum and lump or food being caught at the epigastrium. Patients are able to localize the site correctly in only 70% of cases, with 30% localizing the dysfunction proximally in the esophagus, suprasternal notch, or the throat. Dysphagia can be classified as either oropharyngeal or esophageal Summary 256 (1). Oropharyngeal dysphagia, also called transfer dysphagia, arises from disorders that affect the function of the oropharynx, larynx, and upper esophageal sphincter. Neurogenic and myogenic disorders as well as oropharyngeal tumors are the most common underlying mechanisms for oropharyngeal dysphagia. (2) Esophageal dysphagia arises within the body of the esophagus, the lower esophageal sphincter, or cardia, and is most commonly due to mechanical causes or a