Twitter debate: controversies in dysphagia

The sharp edges of meat bones have a greater chance of perforation than soft food obstructed in the oesophagus. [...]it is important to arrange either a CT scan or at least a chest X-ray prior to undertaking an oesophago-gastro-duodenoscopy (OGD).1 Ideally, endoscopic assessment should be undertaken within 12–24 hours following impaction to reduce the risk of complications, which include perforation, retropharyngeal abscess and/or fistula formation. While typical endoscopic features of EoE include the presence of white exudates, longitudinal and vertical furrows, oesophageal rings and trachealisation of the oesophagus, oesophageal oedema and mucosal friability (crepe paper oesophagus), approximately 10% of patients have either very subtle findings or a completely normal oesophagus.6 7 To increase the diagnostic sensitivity of EoE, at least six biopsies should be taken from at least two different locations in the oesophagus, typically from the distal and proximal halves of the oesophagus.8 There are several treatment options to consider in EoE. Treatment options will be targeted at the cause of dysphagia.18Table 1 Causes, disease process and management options for dysphagia commonly seen in patients with scleroderma Causes of dysphagia Disease process Management Xerostomia Dry mouth Salivary glands unable to produce saliva needed for food lubrication and mastication Drinking water frequently Using artificial saliva Microstomia Abnormal small oral orifice Sclerofibrosis of perioral tissue and malfunctioning of temporomandibular joint Exercises/massages to help stretch the mouth Myositis Pharyngeal dysphagia secondary to muscle impairment and inflammation of striated skeletal muscles necessary for the swallowing process Immunomodulation Oesophageal dysmotility Absent peristalsis and reduced tone of the lower oesophageal sphincter can limit clearance of food, resulting in reflux Smaller bites, chewing more, drinking water with food Gastro-oesophageal reflux disease Proton pump inhibitors Dietary and lifestyle modifications Candida oesophagitis Impaired host–defence system Antifungal therapy Gastroparesis Fibrotic infiltration resulting in subsequent dysfunction of autonomic nerves, smooth muscle and enteric neurons The increased volume of gastric contents results in stomach distension and decreased lower oesophageal sphincter pressure, causing regurgitation of contents into the oesophagus. [...]managing these patients can be quite complex, but it is vital to u