A lady reports to the surgery out patients department three days after a struck fish bone while taking food, with pain inside the neck. She narrates that a fish bone was struck in the throat while taking food; she tried to remove by putting her finger inside the throat, but failed. She again tried to dislodge that by taking bland and dry diet, very much in practice in local folks in India; but failed. She vomited blood while trying to remove it. This type of foreign bodies are usually removed by ENT specialist, and in his absence it came to the surgery OPD. She was examined and nothing could be found, as far as visibility goes in the mouth and throat. She was put to an upper gastrointestinal endoscopy; a nice ulcer covered with scab was visible in the esophagus just below the level of vocal cords. The suspected fish bone was searched up to the exit from the stomach, but in vain. The patient was put on a local anesthetic mixed soothing agent, a proton pump inhibitor and a mild antibiotic. She was advised to take normal diet, not hot; barring chillies and excessive spices. She has not reported back for five days since the advice. It presumed that she is alright.
Many times dentures, fish bones get into throat; but in children different small toys, pins, small batteries, dress hooks and many unusual objects have been recovered. It may sometimes prove fatal, if accidentally finds its way into the respiratory tract. Infants and small children are to be watched while they play, so that nothing is put into mouth; as, at this age they try to gather information about an objects by the lips. So, They put anything and everything to try that and accidentally land in trouble; and the whole family suffers.
The pain; will actually be understood by one who has suffered from it,the burning sensation one gets in the middle of chest. It usually occurs about half an hour to one hour after taking food. Certain foods particular to the individual trigger it. More commonly pickle, dry foods, fad foods, spicy and chilly food are responsible for it. There is regurgitation of fluid and food with burning sensation. It may be mild to severe. By experience person will rush to drink water or antacids to get relief from it.
This is termed as gastroesophageal reflux disease (GERD). It may be a part of acid peptic disease, more commonly. GERD may occur due to a lax lower esophageal sphincter mechanism, in isolation. It may be due to hiatus hernia, herniation of stomach in various proportions into chest through a defect in the diaphragm that separates chest from abdomen. Esophageal dismotility may also cause it. A bad dietary habit is responsible for its exaggeration.
- Barrett’s Esophagus
Diagnosis of it starts from the history of typical symptoms. An endoscopy will show the evidence of the disease. There may be erosions in the mucosa of esophagus. A Barrett’s esophagus, where the normal inner layer is replaced by intestinal pattern. A hiatus hernia also can be distinguished. Esophageal manometric study finds dismotility if any.
The proton pump inhibitors are the main stay of treatment where, no organic problem is noticed.Specific diseases like hiatus hernia and a lax lower esophageal sphincter will require surgical intervention. The surgeries are usually successful. But, before that one may change some of his habits and try to get relief. Refraining from taking water immediately after food, walking in slow pace in the room, not going to bed immediately after taking food and keeping head end up supported by pillow may help. Some Yogic practices like taking deep respiration and exhaling it with full force,repeating it for several times in a session may strengthen the diaphragm to block acid eructation from stomach to esophagus. Barrett’s esophagus requires special mention because it may lead to cancer of esophagus in the long run. If found has to be followed with regular endoscopic reviews.
- Hiatus Hernia
Though a benign disease; it is associated with considerable morbidity, if left untreated. But, the proton pump inhibitors have changed the total outlook of treatment. Many times patients become dependent on it.
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