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PTU-183 Dysphagia With Normal Endoscopic Appearances – Could We Do Better?
  1. V Sehgal,
  2. M Abayalingam,
  3. H Alexander,
  4. A Mitra,
  5. I Ahmed,
  6. B Krishnan,
  7. NV Someren,
  8. K Besherdas
  1. Gastroenterology, Chase Farm Hospital, London, UK

Abstract

Introduction Dysphagia is an ‘alarm symptom’ that merits prompt investigation by gastroscopy to exclude cancer. Cases in whom cancer is diagnosed at endoscopy in the UK are ‘fast tracked’ for multidisciplinary team discussion to plan future management. If endoscopy shows no cancer or intrinsic lesion (peptic stricture, oesophageal ring or web), the cause is usually secondary to oesophageal dysmotility. It is recommended that this group of patients should receive a trial of anti-reflux therapy to exclude reflux-related dysmotility. If no improvement in symptoms is seen patients should be referred for oesophageal physiology studies.

Methods To assess the number of patients who underwent a gastroscopy for dysphagia that had no intrinsic cause found and to evaluate if these patients were managed in line with recommendations.

A retrospective analysis of all patients who underwent a gastroscopy for an indication that included dysphagia at Chase Farm Hospital over a 3-month period (April–June 2012) was performed. Data was obtained from endoscopy reports via the Unisoft GI Reporting Tool (Middlesex) and clinic outcome letters. Intrinsic oesophageal causes for dysphagia were said to be cancer, benign oesophageal stricture and eosinophillic oesophagitis (EE).

Results 106 patients (37 male, 69 female), median age 66 years, were investigated. 28 (26.4%) had an intrinsic cause for dysphagia - benign oesophageal stricture 18 (17%), cancer 8 (7.5%) and EE 2 (1.9%). 78 (73.5%) patients had no intrinsic cause – reflux oesophagitis 26 (32.5%), Barrett’s oesophagus 2 (2.5%), hiatus hernia 28 (35%), gastritis/duodenitis 39 (48.8%), normal 22 (27.5%) and other 13 (16.3%). 55 (70%) of these patients had no follow-up organised after endoscopy. The remaining had clinic review 20 (25.6%), repeat endoscopy 4 (5%) or referral for oesophageal physiology studies 1 (1.3%). 30 (38.5%) patients with no intrinsic cause were prescribed anti-reflux medication after endoscopy. 19 (63.3%) of these patients had no further follow-up. The remaining had clinic review 9 (30%) or a repeat endoscopy 2 (6.7%); none were sent for oesophageal physiology studies.

Conclusion In this study, 75% of patients with dysphagia had no intrinsic cause identified. The majority of patients are discharged from the service without an accurate diagnosis or management recommendation. Our study highlights important shortcomings in the management of patients with a benign cause of dysphagia. We recommend that patients presenting with dysphagia who at endoscopy have no intrinsic cause, be prescribed acid suppression therapy followed by clinical review, and if symptoms persist be considered for oesophageal physiological studies.

Disclosure of Interest None Declared.

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