Oesophagitis is as important as oesophageal stricture diameter in determining dysphagia.

Abstract

It is a common observation that stricture patients with severe dysphagia may have a wide lumen, while others with a narrow stricture have few swallowing complaints. In 64 patients with benign oesophageal stricture the dysphagia score (determined by questionnaire and by a test meal both based on nine different items of food scored according to their solidity) was compared with the diameter of the stricture measured radiologically by premeasured barium spheres. There was evidence of an association, but the correlation coefficient (r) was O0544(p=O00001), suggesting that the diameter of the stricture is an important, although not the sole, determinant of dysphagia. Stricture diameter explains 29-6% (r2) of variation in dysphagia score. The patients (mean dysphagia score 71 of a maximum possible 90) were divided into three groups according to the severity ofoesophagitis (19 patients had minimal, 22 moderate and 23 severe oesophagitis). Analysis revealed the mean dysphagia score to be 83,73,59 in each group respectively. Dysphagia score of each group was significantly different from the others (Kruskal-Wallis test). Relating the dysphagia score to stricture diameter for each group gives correlation coefficient r=0379 (p=OllO) in the minimal oesophagitis group, r=0-651 (p=0-001) in the moderate group, r=0 583 (p=0 004) in the severe group. If both diameter and severity of oesophagitis are included then 66-0% of the variation can be explained. It is concluded that the degree of oesophagitis is as important as luminal diameter in determining swallowing ability.

Dysphagia Referrals to a District General Hospital Gastroenterology Unit: Hard to Swallow

“…Previous studies have shown that esophageal inflammation can be associated with as much swallowing difficulty as frank luminal narrowing [7]. Vomiting and weight loss in association with dysphagia at presentation were significant predictors of malignancy.…”

Impaired Bolus Transit Across the Esophagogastric Junction in Postfundoplication Dysphagia

“…Interestingly, no such relationship existed before fundoplication. Apparently, other factors contribute to dysphagia in patients with GERD, such as esophageal hypersensitivity to distention due to mucosal inflammation (30) or a lowered sensory threshold to bolus distention (31). Furthermore, incomplete esophageal emptying upon peristalsis might be another contributing parameter.…”

The Benign Strictures of the Esophagus

“…This system was associated with the diameter of the stricture at a rate of 30% and esophagitis and other factors at a rate of 70% (23). The dysphagia score displayed parallelism with the diameter of the stricture only in cases in which the esophageal lumen was shorter than 5 mm.…”