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Can patients determine the level of their dysphagia?

World Journal of Gastroenterology 2017年第6期23卷 1038-1043页

作者： Hafiz Hamad Ashraf Joanne Palmer Harry Richard Dalton Carolyn Waters thomas luff Madeline Strugnell Iain Alexander Murray Departments of Gastroenterology Royal Cornwall Hospital NHS Trust Research and Development Royal Cornwall Hospital NHS Trust Clinical Imaging Royal Cornwall Hospital NHS Trust

To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and *** review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obstruction found on endoscopic or radiological examination (if any) was noted. All patients with evidence of obstruction including oesophageal carcinoma, peptic stricture, Schatzki ring, oesophageal pouch and cricopharyngeal hypertrophy were included in the study who had given a perceived level of dysphagia. The upper GI endoscopy reports (barium study where upper GI endoscopy was not performed) were reviewed to confirm the distance of obstructing lesion from central incisors. A previously described anatomical classification of oesophagus was used to define the level of obstruction to be upper, middle or lower oesophagus and this was compared with patient perceived *** thousand six hundred and sixty-eight patients were included, 42.0% of who were female, mean age 70.7 ± 12.8 years old. Of those with obstructing lesions, 726 gave a perceived level of dysphagia: 37.2% had oesophageal cancer, 36.0% peptic stricture, 13.1% pharyngeal pouches, 10.3% Schatzki rings and 3.3% achalasia. Twenty-seven point five percent of patients reported pharyngeal level (upper) dysphagia, 36.9% mid sternal dysphagia and 25.9% lower sternal dysphagia (9.5% reported multiple levels). The level of obstructing lesion seen on diagnostic testing was upper (17.2%), mid (19.4%) or lower (62.9%) or combined (0.3%). When patients localised their level of dysphagia to a single level, the kappa statistic was 0.245 (P < 0.001), indicating fair agreement. 48% of patients reporting a single level of dysphagia

关键词： Deglutition disorders Oesophageal stenosis Oesophageal neoplasm Gastroscopy Fluoroscopy Patient perception Pharyngeal pouch

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