From the Guidelines
An esophagogastroduodenoscopy (EGD) should be performed promptly for patients experiencing dysphagia with solid food intermittently sticking in the chest area, especially if symptoms persist for more than 2-4 weeks or are accompanied by warning signs. These warning signs include age over 50, weight loss, anemia, vomiting, or gastrointestinal bleeding. While waiting for the procedure, patients should modify their diet to softer foods, eat slowly, and ensure proper chewing. The EGD is essential because dysphagia with solids suggests a mechanical obstruction that could indicate serious conditions like esophageal strictures, rings, webs, tumors, or eosinophilic esophagitis. The procedure allows direct visualization of the esophagus, stomach, and duodenum, and enables tissue sampling for diagnosis. Early investigation is crucial as delayed diagnosis of conditions like esophageal cancer can significantly worsen prognosis. No specific medications are typically prescribed before diagnosis, as treatment depends on the underlying cause identified during the EGD, as recommended by recent guidelines 1. Some key points to consider include:
- The importance of considering eosinophilic esophagitis in patients with dysphagia or food bolus obstruction, as it is a common cause of these symptoms 1.
- The role of endoscopy and biopsy in diagnosing eosinophilic esophagitis, particularly in patients with normal endoscopic appearance or with specific endoscopic signs associated with the condition 1.
- The need for prompt evaluation and treatment of patients with dysphagia, as delayed diagnosis can lead to serious complications, such as esophageal cancer or strictures 1. Overall, the decision to perform an EGD should be based on the presence of symptoms and warning signs, rather than waiting for a specific duration of symptoms, as recommended by recent guidelines 1.
From the Research
Dysphagia with Solid Food Intermittently Sticking in the Chest Area
- Dysphagia, or difficulty swallowing, can be caused by various factors, including esophageal strictures, eosinophilic esophagitis, and gastroesophageal reflux disease (GERD) 2.
- When solid food intermittently sticks in the chest area, it is essential to evaluate the patient's symptoms and medical history to determine the underlying cause.
- Esophagogastroduodenoscopy (EGD) is a diagnostic procedure that can help identify the cause of dysphagia, and it is typically performed when a patient experiences persistent or severe symptoms 3, 2.
Indications for EGD
- EGD is usually indicated when a patient experiences dysphagia, particularly if the symptoms are severe, persistent, or worsening over time 2.
- The procedure can help diagnose esophageal strictures, eosinophilic esophagitis, and other conditions that may be causing the dysphagia 3, 4.
- In some cases, EGD may be performed empirically, even if the patient's symptoms are intermittent or mild, to rule out any underlying conditions that may be causing the dysphagia 3.
Diagnostic Yield of EGD
- The diagnostic yield of EGD in patients with dysphagia is relatively high, with studies showing that the procedure can identify the underlying cause of symptoms in over 75% of cases 2.
- However, in some cases, EGD may not identify any abnormalities, and further testing, such as barium esophagram or esophageal high-resolution manometry, may be necessary to diagnose the underlying condition 2.
Treatment Options
- Treatment options for dysphagia depend on the underlying cause, and may include esophageal dilation, medication, or dietary changes 3, 4.
- In some cases, empiric esophageal dilation may be performed, even if the patient's EGD is normal, to help relieve symptoms of dysphagia 3.
- However, the decision to perform EGD or other diagnostic procedures should be made on a case-by-case basis, taking into account the patient's symptoms, medical history, and other factors 2.