Dysphagia recurrent

A. Autonomic dysfunction. Dizziness or syncope or both caused by severe orthostatic hy x>tension occur with an onset from 6 hours to 2 days after ingestion. Orthostatic hypotension is usually accompanied by intact reflex tachycardia. Other manifestations of autonomic neuropathy include dysphagia, recurrent vomiting, and constipation. 

Headache, abdominal pain, arthralgia, recurrent bone pain, nausea, diarrhea, esophageal ulceration, dysphagia... 

Adverse reactions with the bisphosphonates include nausea, diarrhea, increased or recurrent bone pain, headache, dyspepsia, acid regurgitation, dysphagia, and abdominal pain. 

ISPHOSPHONATES The nurse monitors the patient taking the bisphosphonates for any adverse reactions such as nausea, diarrhea, increased or recurrent bone pain, headache dyspepsia, acid regurgitation, dysphagia, and abdominal pain. Analgesic maybe administered for headache Notify the primary health care provider of adverse reactions such as the return of bone pain or severe diarrhea... 

A 57-year-old man with chronic renal insufficiency treated by continuous and ambulatory peritoneal dialysis took cibenzoline 150 mg/day for a ventricular dysrhythmia. Four days later he developed proximal muscle weakness, progressing to generalized muscle weakness, with dysphagia and dysarthria. Hemodiafiltration on six occasions caused complete improvement and cibenzoline was withdrawn. There was no further recurrence, even when other drugs that he had been taking were restarted. 

Manelis G, Aderka D, Manelis J, Horn I. [Recurrent laryngeal nerve palsy and dysphagia for liquids due to vincristine.] Harefuah 1976 91(3 ) 84-5. 

External beam radiation used as sole therapy or in combination with 5-fluorouracil (5 FU) can be used to relieve dysphagia in over two-thirds of patients with SCC. Symptoms recur, however, due to recurrent cancer or fibrotic strictures. The most effective chemotherapeutic regimen in advanced esophageal cancer is epirubicin, cisplatin, and continuous infusion of 5 FU. Two-thirds of cases respond with improvement of dysphagia. ... 

Recurrent dysphagia occurs in 10%-36% of patients and maybe due to stent migration, food bolus obstruction, or recurrent strictures due to tumor ingrowth, tumor overgrowth (Acunas et al. 1996 Cwikiel et al. 1998 Song et al. 1994 Laasch et al. 1998 Saxon et aL 1995 Morgan et al. 1996 Bartelsmann et al. 2000). 

If recurrent dysphagia develops, patients should be evaluated by endoscopy or by esophagography. Endoscopic evaluation is preferable because food bolus obstruction can be cleared endoscopically by pushing the food bolus onwards. Food bolus obstruction can also be cleared by the use of Savary bougies (Froehlich 2000). 

If recurrent dysphagia is due to migration of the stent, a new stent should be inserted. The migrated stent maybe removed or left in situ. 

The majority of s-IBM patients develop dysphagia at some stage of the disease, the frequency varying from 40-80% in different series [6, 8, 9]. While in many cases this is relatively mild and may not even be mentioned by the patients, in some it may lead to recurrent episodes of choking and aspiration pneumonia, and may interfere with adequate nutrition. Videofluoroscopy during swallowing shows... 

Recurrent dysphagia in the early stages following stent placement is usually due to stent displacement which occurs in around 5% of stents placed in the oesophagus proper and around 15% in stents placed across the cardia (BSIR 2004). It is generally wise to remove a displaced stent before re-stenting. 

Late recurrent dysphagia may be due to stent migration or to tumour overgrowth below or, much more frequently, above the stent (Fig. 11.6). In situations where the overgrowth has occurred above the level of the stent, stent removal may prove impossible and over-stenting with a second stent will be necessary. Other techniques to deal with tumour overgrowth such as alcohol injection, laser photocoagulation or photodynamic therapy may also be appropriate. 

Fig. 13.19a,b. A 67 year old man, 6 months after Akyiama s procedure presents with dysphagia. Endoscopy was planned immediately after video fluoroscopy and so, water soluble contrast material was chosen, a RPO oblique projection shows a local enlargement of the retrotracheal space, the distance between the trachea and the cervical esophagus is widened (arrows), b A.P view revealed a lobulated mass with narrowing at the level of the anastomosis. Recurrent oesophageal tumour was diagnosed endoscopically... 

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