Liquid medication please: an esophageal stricture case report.

A 78-year-old male presented with a chief complaint of sinus congestion and a non-productive cough of several months' duration. His physical examination including lung auscultation appeared unremarkable. When discussing his prescriptions, the patient requested his medications in liquid form. Upon further questioning, he indicated a 1-year history of inability to swallow pills. The patient denied problems ingesting solids or liquids. In addition, he reported occasional heartburn but no recent fever, night sweats, or weight loss. Diagnostic studies initiated included a modified barium swallow. After the patient received a barium pill his study revealed a moderate stricture at the gastroesophageal junction with obstruction of the pill. A subsequent chest x-ray confirmed an ovoid density remaining in the distal esophagus. Gastroenterology consultation was obtained and endoscopy confirmed a smooth and symmetrical 8-mm-wide stricture. Balloon dilation of the stricture was accomplished and passing of the endoscope followed. The patient was placed on a thick liquid diet and a proton pump inhibitor at the time of discharge. During his follow up visits, he indicated significant improvement swallowing. Geriatric patients are susceptible to esophageal dysphagia resulting from both obstructing and neuromuscular disorders. Many senior patients compensate for their swallowing abnormality by modifying their diet and adopting new swallowing techniques. If untreated, esophageal strictures may lead to malnutrition, esophageal injury, or recurrent pain. Geriatricians should remain aware that senior patients frequently avoid evaluation of a potentially serious problem by attributing their difficulty to normal aging.

Jose E. Lares, James Bernick, MD, Amitbha Banerjee, MD, and Salem Muayod, MD. San Jacinto Methodist Hospital, Baytown, TX.