Modified Monday: (Esophageal) Narrowing it down
Esophageal problems can present clinically as oropharyngeal dysphagia and we need imaging to tell the difference. Period.
We thought about leaving the above as the full write up for this week...but decided to go ahead and add a little bit more information. Our study today from Cincinnati is a patient that presented with complaints of “food not going all the way down” and getting “stuck in the throat”, stating that he had to “drink tons of water to get down solid food”. He also showed coughing pretty consistently post swallow with all PO. The clinical eval completed in acute care stated suspect post swallow residue and changed the diet to puree. The patient said the puree was a little easier, but did NOT enjoy and hadn’t been eating much. He was discharged to the SNF without imaging, the diet order followed him. He was in therapy for a week or so, still not eating much, continuing to lose weight, continuing to cough.
The SNF made the recommendation for an MBS study, and our team found a lovely normal swallow, and severe esophageal dysmotility. He was eventually diagnosed with a hiatal hernia and a Schatzki’s ring. In the clip, you can briefly see the narrowing of the distal esophagus.
Clinical symptoms of feeling of food in the pharynx, needing liquid washes, and yes…even coughing - are all potential signs of something happening in the esophagus. They are also potential signs of poor pharyngeal contraction leaving residues in the pharynx post swallow, incomplete base of tongue retraction with severe vallecular residue, etc etc etc. The point is… changing a diet due to nonspecific symptoms is not without consequences and/or a negative impact on the medical status of the patient, and we need to be sure that we have a reason-a GOOD reason-for doing it. Period.