My father has a feeling that his food is getting stuck and takes time to settle. What could this be?

Question

Hi doctor,

I am looking for a second opinion on a barium x-ray performed for my father. He had the feeling that his food is getting stuck and takes time to settle. He had a barium x-ray done. The radiologists' report shows normal, so we need to confirm it. He has a previous history of diabetes and allergy.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Well, barium swallow reporting requires a lot of expertise, mainly if a timed barium esophagogram (TBE) is performed. I would be able to guide you if you can see the images of it. Secondly, I would need you to tell me some more information about your father, which would help me establish the underlying cause.

For how long does he have difficulty swallowing?
Is this progressive like worsening than before?
Is it to liquids and solids only or both? And if both, does all started at once?
Where exactly he feels that the food is stuck? Over throat, mid of chest, or just at the stomach area?
Does he have any acid reflux in the past?
Does he smoke? Or any other addiction?

Let me know; I can figure out the potential cause in him. He might require some more investigations like endoscopy to confirm things.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I can understand his and your concern about not going for endoscopy. Still, after my overall assessment and after reviewing the images plus a radiology report (attachment removed to protect patient identity), I believe the endoscopy is the most sensible investigation to do. In images, there is no problem with the cervical esophagus (neck region) or mid to lower esophagus (chest region), and contrast is freely flowing in the stomach. However, there is a narrowing of the stomach, which is unable to distend properly. The radiologist has reported this a linitis plastica (leather stomach or non-distended stomach), a sign of stomach cancer. Please do not get panicked with this, the radiological findings sometimes appear as with no reason, and the sensible step is to rule out this with a gastroscopy. There may be some ulceration in the esophagus, causing him difficulty in swallowing, feeling of trapped air, and feeling relieved after burping. This thing will also be looked at closely and thoroughly with gastroscopy.

The gastroscopy or esophagogastroduodenoscopy EGD is a simple procedure whereby an endoscopist, after sedation of the patients, passes an 11 to 13 mm diameter scope via the mouth into the esophagus (food pipe) and stomach. The procedure takes no more than 3 to 5 minutes. The endoscopist would see the lining of the esophagus and stomach, and in this case, it would observe the distensibility of the stomach by pouring gas. In the last endoscopist would take a biopsy of the suspicious areas. Let me know if I can discuss your father's concern regarding the procedure or any particular fears I can manage.

Thank you.