Uncle Dave is at it again. For about the fifth time in the past few months, he’s had to excuse himself from the Sunday family dinner and retreat to the bathroom to privately ‘cough up’ a piece of food that’s stuck in his throat. For Uncle Dave, it’s become harder and harder to swallow – so much so that now even soft foods like scrambled eggs are getting stuck.
What Uncle Dave hasn’t yet realized is that he needs to see a doctor immediately – so his condition, known as “esophageal stricture” may be diagnosed and treated on an outpatient basis before it evolves into a full-fledged emergency situation.
“Typically, patients with esophageal food obstruction notice that they’re having difficulty swallowing their food – be it cornbread-and-milk or pieces of steak or chicken,” says Dr. Mark Appler, a gastroenterologist who knows a thing or two about food obstruction – which seems to have a higher rate of occurrence in Surry County (including Mount Airy) than surrounding regions.
The culprit could be scar tissue
Having practiced more than 30 years at Northern Hospital of Surry County, Dr. Appler has successfully treated hundreds of patients for the potentially life-threatening problem. As he explains, esophageal food obstruction is not the same as a one-time event when food “goes down the wrong pipe” and gets stuck in the “wind pipe,” affecting breathing. Rather, it occurs when food gets stuck repeatedly in the “food pipe” due to a constant and dangerous narrowing of the gastro-esophageal junction, the portion of the esophagus that links it with the stomach.
In most patients with this problem, the lower esophagus begins to narrow as scar tissue forms on the esophageal wall after repeated exposure to stomach acid – which results from chronic indigestion or acid reflux (heart-burn). As more scar tissue builds up, the passageway becomes narrower and narrower — making it more and more difficult, if not impossible, for food to pass.
Patients who experience difficulty swallowing can be accurately diagnosed with a series of X-rays images, which are taken after the patient drinks a liquid barium solution and swallows a mini-marshmallow (like the ones placed on top of hot chocolate!). A careful review of the images permits Dr. Appler to both confirm the diagnosis and pinpoint exactly the esophageal stricture – which, as he explains, is “the spot where the marshmallow will get jammed up.” The X-rays also enable Dr. Appler to be sure there is no sign of esophageal cancer, which can cause similar swallowing problems.
Esophageal dilation: To widen the throat
For most patients, Dr. Appler recommends an esophageal dilation, a “stretching” procedure that effectively widens the blocked esophageal passageway so that food may once again pass unimpeded. The 20-minute procedure, typically done while the patient is under general anesthesia, is performed in Northern Hospital’s Day Surgery Suite. Dr. Appler uses his extensive clinical experience and hand-eye coordination to carefully glide a lubricated flexible tube, called a dilator, down the esophagus. He then repeats that process several more times – with progressively wider dilators – until the affected area has been sufficiently stretched. In most cases, dilation corrects the problem, which is then maintained with daily antacid medication.
Dr. Appler cautions that patients should see their doctor “sooner rather than later” if they’re having trouble swallowing. “As a planned procedure, the risk of causing a tear in the esophagus during dilation is 1 in 1,000; But when you come to the emergency room in the middle of the night, when the food has already become tightly lodged in the esophagus, the risk of perforation is 10 times higher, or 1 in 100,” he says.
Dr. Appler’s expertise in treating digestive diseases has been fine-tuned over the past 37 years, right after earning his medical degree from Wake Forest University School of Medicine in 1980. He then completed a three-year residency in Internal Medicine at a major teaching hospital in Baltimore; followed by an intensive two-year fellowship in Gastroenterology at the University of Pittsburgh.
With his advanced training completed, he and his wife, Kate (well-known for her years of community involvement) returned to North Carolina to raise their family. “Truth be told, back in 1980 this area was a little dull for a young bachelor” he quips, “but once I got married, Kate and I knew we wanted to start and raise our family here in Mount Airy.”
Full range of GI capabilities
In addition to treating food obstruction, Dr. Appler and Dr. Tom Orli, his medical colleague at Northern Hospital, also diagnose and treat all other gastrointestinal (GI) diseases and digestive disorders, including stomach ulcers, ulcerative colitis, Crohn’s disease, Irritable Bowel Syndrome, diverticulitis, celiac disease, colon polyps, and bowel control disorders. For more information, visit www.northernhospital.com