Difficulty Swallowing (Dysphagia)
This is a complex and often subtle symptom to describe. Any feeling of difficulty when swallowing that occurs on a regular basis is abnormal, but many patients will unconsciously change how they eat to avoid symptoms which will, therefore, delay them seeking diagnosis and treatment. For example, if someone finds they can no longer comfortably eat chicken, meat or bread they will often just stop eating these things and carry on as though there is nothing wrong. Many people with swallowing difficulties will delay seeking medical help until they can no longer easily swallow liquids, or when vomiting/regurgitation disturbs their mealtimes. When asking about difficulty swallowing we wish to find out if they can tolerate solid food, soft food or liquids.
Oesophageal Testing Dysphagia/Swallowing Function Testing
Barium Swallow
This is an X-Ray test whereby someone swallows a thick fluid +/- bread or a marshmallow, and the progress of what they have swallowed is followed on x-ray from the mouth and down into the stomach. This is a quick, painless and simple test that can be done at many X-ray labs. It is an easy test to organise when someone has unexplained swallowing problems or reflux, but it isn’t as accurate as manometry (see below).
Manometry
This is the single most important test we can do on someone with a suspected oesophageal disorder. After some local anaesthetic is swallowed and sprayed into the back of the nose, a fine catheter is passed via the nose into the oesophagus in order to measure the strength and co-ordination of oesophageal contraction, and to measure the function of the muscular sphincters that are at the upper and lower end of the oesophagus. The catheter is passed relatively easily for the large majority of people and takes about 5 minutes, during which time you are asked to swallow a couple of mouthfuls of water and soft food. We choose different catheters depending on what information is required, and in general, a large amount of information can be obtained from what is a relatively simple test.
Achalasia
Achalasia is the most common major swallowing disorder. Diagnosis is often delayed for many years because patients learn to put up with their symptoms and because often an achalasia sufferer’s gastroscopy looks normal so they are told that there is “nothing wrong”. Achalasia causes chest pain, regurgitation of food, dysphagia and weight loss. At Upper GI Surgery we offer all of the diagnostic tests for this and other swallowing conditions. We are the only clinic in NSW experienced in the diagnosis and all of the treatment modalities for Achalasia including Surgical Myotomy (Heller), Per Oral Endoscopic Myotomy (POEM), Pneumatic dilation and Botox therapy.
