[DYSPHAGIA] re: patient with esophageal diverticuli

[kgoertz@pahd.sk.ca (Clarke-Goertz, Kim (PAHD))]

Dear Group,

I'm hoping someone can suggest aide for an 82yo gentleman who is currently
residing in a long-term care facility suffering from esophageal stricture.
He ended up in long-term care because the private care home he was in
couldn't handle his care needs anymore (due to the vomiting of food and
spitting secretions).  

He has been on a pureed diet for the past 12 weeks due to "choking, gagging
and vomiting at the dinner table".  His medical history includes: emphysema,
prostatic hypertrophy, osteoporosis and osteoarthritis, costochrondritis and
COPD.  In addition to the difficulty passing food through his esophagus, he
is complaining of difficulty breathing as of late (likely due to clogging of
pharynx and oral cavity with secretions/vomitus?).

He is not able to keep solids down at this point (regardless of how
runny/thin). They are trying him on liquids with nutritional supplements,
however, he vomits frequently and has difficulty even managing his own
secretions (he spits them out).  The RN I spoke with today mentioned drying
up the secretions with scopolamine and then we discussed the possible ill
effects of that re: aspiration, drying tissue, etc. and so she is not sure
where to go.

If you're wondering where the physician is in all of this, so am I!  I asked
what was being done for this gentleman medically and apparently his
physician is away this week.  However, he has a daughter who is a critical
care nurse, so she is doing much of the case management/investigation.

I just spoke with this gentleman's daughter who relayed the following:
-he was scoped by GI in the Spring of 2000, at which time they saw a
stricture, they dilated him and he did well for 6 months with no symptoms.
He returned for another dilitation and they had difficulty passing the tube
down (couldn't get him dilated very far) and as a result, that treatment was
not effective short or long term.  Following that, in September of this
year, he went back for a 3rd dilitation at which time the GI doc noted
pockets of diverticuli all over his esophagus that he hadn't had before -
and they could not do any further dilitation b/c of risk of rupture.

So, the daughter plans to speak with this same GI doc to see if there's
anything further that can be done, but she is not terribly optimistic re:
treatment options, as, if there were any, they would already have been
tried.
I told her I would pose the question on this listserv to see if anyone has
had a similar case/experience and what other treatment options might be
available.

As well, I wanted to ask about PO foods/liquids in a case like this.  The
daughter plans to speak with her father today about the option of a feeding
tube coupled with liquids/thin purees for oral pleasure as tolerated.
Apparently he likes candies (only negative being, that it would increase
saliva production, but I guess you can't take away all pleasures! - a bit of
a catch-22).  I wonder (as I don't know) if there are any foods/liquids that
would possibly irritate the lining of the esophagus in a case such as this,
that this man should avoid.  Does anyone out there know of any?

Any and all replies will be much appreciated.  Thanks in advance and also my
apologies for the length of this post.

Kim


Kim Clarke-Goertz CCC-SLP (C)

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