Cho Yu Kyung
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Gastroenterol. 2021 Feb 25;77(2):71-76. doi: 10.4166/kjg.2021.024.
Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. In the case of dysphagia due to esophageal motility disorder, whether it is the major motility disorder or minor motility disorder should be identified in high resolution manometry. Major motility disorders show esophagogastric junction obstruction or major peristaltic defects. In this case, the severity of the symptoms should be assessed and patients who need endoscopic or surgical treatment targeting lower esophageal sphincter should be screened. Impaired lower esophageal sphincter relaxation (achalasia, esophagogastric junction outflow obstruction, esophageal spasm or abnormal hypercontraction (jackhammer esophagus), hypotensive contraction (ineffective esophageal motility, failed peristalsis), esophageal hypersensitivity (noncardiac chest pain), gastroesophageal reflux disease and esophageal bolus stasis are the possible mechanisms causing dysphagia symptoms. The proper medical treatment depends on underlying mechanisms.
食管吞咽困难患者需要采取逐步的诊断和治疗方法。内镜检查及活检和食管钡餐造影是评估解剖学异常和食管团块淤滞的必要检查。还需要进一步的影像学检查或食管功能测试，如高分辨率食管测压、功能性腔内成像探头、CT或内镜超声检查。对于因食管动力障碍导致的吞咽困难，应在高分辨率测压中确定是主要动力障碍还是次要动力障碍。主要动力障碍表现为食管胃交界部梗阻或主要蠕动缺陷。在这种情况下，应评估症状的严重程度，并筛选出需要针对食管下括约肌进行内镜或手术治疗的患者。食管下括约肌松弛受损（贲门失弛缓症、食管胃交界部流出道梗阻、食管痉挛或异常高收缩（胡桃夹食管）、低张力收缩（无效食管动力、蠕动失败）、食管超敏反应（非心源性胸痛）、胃食管反流病和食管团块淤滞是导致吞咽困难症状的可能机制。恰当的药物治疗取决于潜在机制。
