How Do We Evaluate Dysphagia at Houston Heartburn and Reflux Center?

How Do We Evaluate Dysphagia at Houston Heartburn and Reflux Center?

Bruce from Houston sent us this question: “I was diagnosed with dysphagia.
Last week my GI did an endoscopy and this week I have an esophageal manometry test.
I’ve been suffering for a month with a tight throat, pain in my throat and chest, pain in my eyes and ears. Liquid mucous is burped up often daily. I must sleep upright, or my throat closes up with pain. I changed my diet to veggies, soups, coconut milk puddings, sometimes plain chicken, quinoa with coconut milk, oatmeal. I also stopped eating bread and cut down on sugar and coffee. No alcohol. I do smoke about 8 cigarettes a day.
Do you have any suggestions for any medical testing, supplements or my diet? Thank you”

Dear Bruce,

Dysphagia or difficulty swallowing food is a common symptom for acid reflux patients. It often indicates advanced disease and stage 3 or 4 GERD. Recurrent and long-term acid reflux damages esophageal motility. Esophageal motility is a coordinated process that propels solid or liquid food through your food pipe into stomach. Weak and poorly coordinated esophagus contractions result in slow and incomplete food bolus movement. Acid reflux patients often report food getting stuck in the esophagus. Heartburn patients develop the habit of sipping on water after each bite of steak or bread to facilitate swallowing. Esophageal motility is best evaluated using manometry. Manometry is an outpatient test that does not require sedation. It takes about 30 minutes to complete. The test measures with high accuracy esophageal contractions and pressure in lower esophageal sphincter. Pressure in lower esophageal sphincter may be elevated in acid reflux patients due to excess scar tissue formation around distal esophagus. Scar tissue develops secondary to chronic inflammation due to acid reflux. Scarring may occur within the esophageal wall (less common these days due to PPI use) or around esophageal wall. Failure of lower esophageal sphincter to relax with each swallow results in esophageal outflow obstruction and dysphagia.

Other causes for dysphagia include achalasia, Schatzki’s ring, large hiatal hernia, and esophageal cancer. Acid reflux is a risk for esophageal cancer. Esophageal cancer starts developing along the lining of distal esophagus. As cancer grows, it partially obstructs esophageal lumen resulting in dysphagia. Upper endoscopy is an important test performed under sedation to visualize the inside of esophagus. The scope is inserted through the mouth and into the esophagus. Inflamed areas, polyps, lesions and ulcers are biopsied and sent for pathological examination.

Severe acid reflux disease causing dysphagia is not treated with diet or supplements. Diet does not cause acid reflux. Rather a weak anti-reflux barrier allows acid in the stomach to escape into the esophagus. Stomach content is always acidic whether you eat or not. In order to stop acid reflux, the anti-reflux barrier must be resorted. For stage 3 and 4 acid reflux disease, Houston Heartburn and Reflux Center specialists recommend hiatal hernia repair and Nissen fundoplication. Nissen fundoplication, when properly performed, is currently the most effective and most reliable treatment for GERD.