Differential Diagnosis for Esophageal Food Bolus
Single Most Likely Diagnosis
- Esophageal Dysmotility: The patient's symptoms of difficulty swallowing, feeling of food bolus in the esophagus, and need to regurgitate suggest a motility disorder. The fact that he is 79 years old and has no history of stricture or esophageal cancer makes this a likely diagnosis.
Other Likely Diagnoses
- Esophagitis: Inflammation of the esophagus could cause difficulty swallowing and a feeling of food being stuck. The patient's recent consumption of chicken could have triggered or exacerbated the condition.
- Gastroesophageal Reflux Disease (GERD): GERD could cause symptoms similar to esophageal dysmotility, including difficulty swallowing and regurgitation of food.
- Achalasia: Although less common, achalasia is a motility disorder that could cause the patient's symptoms, including difficulty swallowing and regurgitation of food.
Do Not Miss Diagnoses
- Esophageal Stricture: Although the patient denies a history of stricture, it is essential to rule out this condition, as it can cause severe symptoms and complications if left untreated.
- Esophageal Cancer: Similarly, although the patient denies a history of esophageal cancer, it is crucial to consider this diagnosis, as it can be life-threatening if not promptly treated.
- Foreign Body Obstruction: The patient's symptoms could be caused by a foreign body, such as a bone or other object, lodged in the esophagus.
Rare Diagnoses
- Eosinophilic Esophagitis: A rare condition characterized by inflammation of the esophagus caused by an allergic reaction, which could cause difficulty swallowing and a feeling of food being stuck.
- Scleroderma: A rare autoimmune disorder that can cause esophageal dysmotility and other gastrointestinal symptoms.
- Chagas Disease: A rare parasitic infection that can cause esophageal dysmotility and other gastrointestinal symptoms.
Regarding the use of glucagon and Reglan (metoclopramide) to help pass the bolus, glucagon may be considered as it can help relax the esophageal smooth muscle and aid in the passage of the food bolus. However, its effectiveness is variable, and it may not be suitable for all patients. Reglan, on the other hand, is a prokinetic agent that can help stimulate esophageal motility, but its use in this setting is not well established, and it may not be effective in passing the bolus. A more appropriate initial approach would be to try to dislodge the bolus using other methods, such as drinking water or other liquids, and then consider further evaluation and treatment if the symptoms persist.