Recent advances in dysphagia management

Abstract

The literal definition of dysphagia is "disturbed eating". However, it is more accurately described in clinical practice as a sensation of food or liquid being stuck in the esophagus or chest. If this sensation is associated with pain, it is labeled odynophagia, and if it is associated with persistent obstruction and bolus retention, it is categorized as a food impaction. Through research and technological advances, we continue to expand our understanding of the etiologies and underlying pathophysiology relating to this complaint. However, for now, our clinical algorithms focus on endoscopy and manometry to break down dysphagia into three categories: obstructive dysphagia, esophageal motility disorders, and functional dysphagia. Here, we review some critical pitfalls in our current clinical diagnoses, new proposed underlying mechanisms of esophageal motor disorders, and developing technologies to aid in diagnosis and treatment.

Keywords: EGJOO; FLIP; dysphagia; esophagus; jackhammer; manometry.

Figure 1.. Treatment algorithm for patients presenting with esophageal dysphagia.

EGD, esophageal dysphagia; EGJ-DI, esophagogastric junction-distensibility index; EGJOO, esophagogastric junction outflow obstruction; FLIP, functional luminal imaging probe; f/u, follow-up; GERD, gastroesophageal reflux disease; HRM, high-resolution manometry; LA, Los Angeles Classification; NL, normal; PD, pneumatic dilation; PPI, proton pump inhibitor; RAC, repetitive antegrade contraction; TBE, timed barium esophagogram; Tx, treatment. Figure courtesy of the Northwestern Esophageal Center.

Figure 2.. High-resolution manometric patterns (top) and the corresponding functional luminal imaging probe panometry patterns (bottom).

EGJ, esophagogastric junction; EGJ-DI, esophagogastric junction-distensibility index; RACS, repetitive antegrade contractions; RRC, repetitive retrograde contraction.