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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diagnosed with interstitial lung disease. Endoscopy showed candidiasis. Took medicine

Answered by
Dr. Mayank Bhargava

Internal Medicine Specialist

Practicing since :2003

Answered : 1658 Questions

Posted on Fri, 15 Nov 2013 in General Health
Question: My father in law has been diagnosed with interstitial lung disease. Some times he starts choking while having food. About an year back doctor advised endoscopy which detected candidiasis for which he took medications and he became normal. Now his choking while having food has come back again - happens sometimes. What should be done when it happens? He is consulting a chest specialist who has mentioned that his lungs have become weak due to old age. His age is 77.
Answered by Dr. Mayank Bhargava 35 minutes later
Brief Answer:
Hi XXXX, Welcome to XXXXXXX forum

Detailed Answer:
Welcome to XXXXXXX forum.

Let me know his associated features along with mentioned.
Does he has pain while swallowing/ coughing while swallowing/ chest heaviness/ skin tightness?
Does he has difficulty in opening mouth/ weakness in any limbs/ facial weakness?

With the available described details, there could be possibility of disturbed esophageal (food pipe) motility causing difficulty in swallowing with choking sensation.
Esophageal dysfunction may cause hindrance in propulsion of food ahead.

Esophageal dysfunction could be due to weakness of smooth & skeletal muscles in esophagus.
Weakness could be a part of central nervous system (brain cause which is known as pseudobulbar palsy) or could be a part of syndrome such as interstitial lung disease/ connective tissue disorders.

Esophageal candidiasis could also be contributory factor for difficulty in swallowing.

You should consult with XXXXXXX medicine specialist/ neurologist and should go for thorough check up. Complete neurological and gastrointestinal evaluation is mandatory before making any diagnosis.

He should also go for complete blood count, erythrocyte sedimentation rate, ANA, anticentromere antibodies (for scleroderma), MRI brain (to rule out brain cause for esophageal muscular weakness) and repeat endoscopy.

Weakness of esophageal muscular weakness can be confirmed clinically by putting Ryle's tube via nose to Upper gastrointestinal tract.
If liquid food given via Ryle's tube can be tolerated and not vomited out then esophageal muscular weakness can be partially confirmed.

Treatment depends on exact diagnosis.
In my personal opinion, you should go for placement of ryle's tube for better feeding.
If Ryle's tube feeding is not accepted by your father in law, then kindly prefer liquid diet only in sitting position.
Avoid hard food stuff.

Take care,
Let me know your other associated query.
Wishing a speedy recovery.
Dr. Mayank Bhargava
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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