Dysphagia, Reflux, and Hiccups

  • Amy A. Shorthouse
  • Rebecca K. S. Wong
Chapter

Abstract

Dysphagia, reflux, and hiccups are common gastrointestinal symptoms in cancer patients. They may arise either from the underlying disease or as an acute or late complication of treatment and is particularly common in patients with upper gastrointestinal and head and neck malignancy. These symptoms can have serious adverse effects, including on nutritional status and quality of life.

In patients experiencing dysphagia as an acute side effect of chemotherapy or radiotherapy, most consistently seen in patients undergoing treatment for head and neck and advanced lung cancer, aggressive nutritional and supportive care, including feeding tube insertion, may be required. Late toxicity such as esophageal stricture may require endoscopic dilatation. For patients with direct tumor involvement such as esophageal cancer, optimal management options include supportive measures (hydration, nutritional support), mechanical measures (dilatation, endoscopic stenting), and antineoplastic measures (external beam radiotherapy, brachytherapy, or chemotherapy).

Gastroesophageal reflux can arise as a result of malignant involvement of the stomach or esophagus, esophagitis and gastritis due to chemotherapy, radiotherapy, supportive medications and candidiasis of Helicobacter pylori infection. Management including dietary modifications and empirical treatment with a proton pump inhibitor represent the mainstay of therapy.

Persistent hiccups can indicate serious underlying pathology including malignant involvement of the gastrointestinal tract. The evidence in support of treatment efficacy is extremely sparse. A rational approach involves treating the underlying cause, removing exacerbating factors, and using pharmacological interventions with chlorpromazine, baclofen, or gabapentin being common agents of choice.

Keywords

Toxicity Dopamine Aspirin Paclitaxel Dexamethasone 

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Copyright information

© Society for Imaging Informatics in Medicine 2010

Authors and Affiliations

  • Amy A. Shorthouse
  • Rebecca K. S. Wong
    • 1
  1. 1.Radiation Medicine ProgramPrincess Margaret HospitalTorontoCanada

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