1. Dysphagia

  1. John N. Plevris MD, PhD, FRCPE, FEBGH2 and
  2. Colin W. Howden MD, FRCP (Glasg.), FACP, AGAF, FACG3
  1. Nirmala Gonsalves MD1,
  2. Ikuo Hirano MD1 and
  3. John N. Plevris MD, PhD, FRCPE, FEBGH2

Published Online: 29 NOV 2011

DOI: 10.1002/9781444346381.ch1

Problem-Based Approach to Gastroenterology and Hepatology

Problem-Based Approach to Gastroenterology and Hepatology

How to Cite

Gonsalves, N., Hirano, I. and Plevris, J. N. (2012) Dysphagia, in Problem-Based Approach to Gastroenterology and Hepatology (eds J. N. Plevris and C. W. Howden), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346381.ch1

Editor Information

  1. 2

    Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

  2. 3

    Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Author Information

  1. 1

    Division of Gastroenterology, Northwestern University – The Feinberg School of Medicine, Chicago, IL, USA

  2. 2

    Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

Publication History

  1. Published Online: 29 NOV 2011
  2. Published Print: 17 JAN 2012

ISBN Information

Print ISBN: 9781405182270

Online ISBN: 9781444346381

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Keywords:

  • achalasia;
  • eosinophilic esophagitis;
  • dysphagia;
  • esophageal motility;
  • food allergy

Summary

Dysphagia is an important symptom that warrants a diagnostic evaluation for an organic etiology that is generally treatable. Esophageal motility disorders are an important cause of dysphagia that may escape detection on initial radiological and endoscopic testing. Although uncommon, achalasia is an important disease that is the best understood and most readily treatable esophageal motility disorder. It serves as a prototype for disorders of the enteric nervous system with degeneration of the myenteric neurons that innervate the esophagus. Recognition of the clinical presentation and manometric features is necessary for appropriate management. Treatment studies have demonstrated the limited efficacy of botulinum toxin as well as the less than ideal, long-term effectiveness of both pneumatic dilation and Heller's myotomy. Eosinophilic esophagitis (EoE) is another cause of esophageal dysphagia that is increasingly being recognized as one of the most common causes of dysphagia in both children and adults. Food and environmental allergy, host immunological predisposition and interactions with gastroesophageal reflux disease have emerged as important aspects of the disease. Therapeutic options include medical therapy with acid suppression, corticosteroids and biologic agents. Elimination diets and endoscopic esophageal dilation have demonstrated effectiveness.