{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 1, Ep 3 of 3: Post-surgical and Systemic Dysphagia","html":"","width":"100%","height":180,"duration":562,"description":"The dysphagias the standard scope-then-manometry workup misses: those after fundoplication and bariatric surgery, and those reaching the esophagus from systemic disease. The unifying skill is knowing which history question surfaces the surgical or systemic story the scope report cannot carry.\n \nTopics covered\n\nPost-fundoplication dysphagia patterns\nPost-bariatric surgery dysphagia\nScleroderma esophagus\nSjogren and sicca-related dysphagia\nEsophageal amyloidosis\nNeuromuscular oropharyngeal dysphagia\nRadiation esophageal injury\nBarium swallow versus endoscopy\n \n \nKey decisions\n\nFirst test for post-fundoplication dysphagia is a barium swallow, not a scope, because it shows wrap shape and junction position; a too-tight wrap is dilated early to save revision surgery.\nA slipped wrap gives both recurrent reflux and dysphagia because the wrap slides onto the stomach; telescoping produces the same combination with an intact wrap.\nSleeve gastrectomy worsens reflux by raising intragastric pressure and flattening the angle of His, so gastric bypass is the reflux-friendly bariatric operation; bypass dysphagia is anastomotic stricture treated with endoscopic dilation.\nScleroderma manometry shows failed contractions on nearly every swallow plus a weak lower sphincter, distinguishing it from achalasia where the sphincter fails to relax with high relaxation pressure.\nAvoid fundoplication in scleroderma because a wrap needs a working peristaltic pump; wrapping an aperistaltic esophagus trades reflux for obstruction.\nMacroglossia points to AL amyloid; work up with serum and urine immunofixation, free light chains, and marrow biopsy, and treat the underlying process rather than the esophagus.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Esophageal Symptoms and Diagnostic...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}