Question

TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years. TS denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer. He does not drink alcohol, although he drank heavily many years ago. He does not smoke. TS describes the dysphagia this way: “Food gets stuck in my throat, and I can’t get it down.” The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals. He is scheduled for an upper gastrointestinal endoscopy. Questions and topics for discussion: What is the likely cause of his dysphagia? What advice should TS be given regarding his OTC medication at this time? What are the usual signs and symptoms of GERD? How will it be managed?

Answer 1

Dysphagia is the condition where there is inability to swallow certai foods or liquids in sopme people and some others can't swallow at all.

Causes of dysphagia:

• neurological disorders like stroke,head injury,dementia
• cancer of the mouth and esophagus
• Gastro esophageal reflux disease (GERD),the condition in which the gastric contents are moved back to the esophagus.

Advice regarding Naproxen:

Naproxen is a non steroid anti inflammatory drug and this would aggravate his sypmtoms of GERD and heartburn .This factor is considered as a red flag relating to GERD by doctors.

GERD is not a disease ,it is a syndrome in which the gastric contents are moved into esophagus.Signs and symptoms of GERD are as follows:

• heartburn usually after eating and worseneing especially at night
• senastion of a lump in the throat
• chest pain
• difficulty in swallowing
• regurgitation of food and sour liquid

GERD can be managed by:

• medications like antacids,H2 receptor antagonists (Cimetidine),proton pump inhibitors(Omeprazole,lansoprazole)
• Baclofen which strengthens the lower esophageal sphincter

GERD can also be treated by certain surgical procedures like fundoplication,LINX device,transoral incisionless fundoplication.