Esophageal disorders and influence in driving

Dysphagia

Dysphagia is the subjective feeling of difficulty in swallowing, due to a poor progression of the matter taken from the pharynx to the stomach, and can be associated with pain.

Liquid and solid transport can be hindered by organic injuries of the pharynx, the esophagus, the adjacent organs, or by functional disorders of the nervous system and muscles.

Pharyngeal dysphagia is observed in patients with neurological or muscular disorders such as dermatomyositis, myasthenia gravis, muscle dystrophy, central nervous system injuries, etc. They often show nasal regurgitation or tracheal aspiration followed by cough.

Repeated aspiration of digestive matter to the bronchial tree can lead to chronic pulmonary disease.

Esophageal dysphagia can be due to obstructive conditions including tumors, ulcers, peptic stenosis, or be caused by motor disorders affecting esophageal peristalsis and lower esophageal sphincter (LES) function, such as achalasia and scleroderma.

Esophageal dysphagia is also caused by the adjacent organs that can compress the esophagus such as enlargement of the left atrium, aneurism of the aorta, retrosternal thyroid, pulmonary tumors, etc.

Advice on Dysphagia

• It is not advisable to eat while driving. The driver is distracted and his hands are busy with something that is not driving or the car commands.
• The patient with dysphagia has the added risk of aspiration, with a sudden episode of cough and anxiety, and the subsequent loss of control of the car.
• To take food or drinks, the car should be stopped without blocking traffic.

Chest pain

• Chest pain of esophageal origin can occur for the presence of acid in the esophagus due to gastroesophageal reflux, or pain on swallowing for esophagitis, tumors, infections, or spontaneous pain in motor disorders mimicking angina pectoris.

The combination of dysphagia and chest pain guides the judgment to an esophageal origin and its treatment is causal.

In the cases of pain caused by motor disorders such as achalasia and diffuse esophageal spasticity, calcium channel blockers, including verapamil and nifedipine are useful, as well as nitrates as sublingual nitroglycerin. In selected cases, LES expansion or surgery will be carried out.

Adverse events of drugs and their influence on driving:

• Nitroglycerin can lead to headache, dizziness, and hypotension that prevent from driving.
• Verapamil can cause bradycardia, hypotension, A-V blockage, and heart failure.
• Nifedipine enhances the appearance of tachycardia, hypotension, headache, and can limit reactivity, so caution should be exerted when driving.

Advice on Chest pain of esophageal origin

• The driver suffering an episode of chest pain already known should immediately stop the car in area free from traffic, change his position and, if indicated, take the medication prescribed by his physician.
• If chest pain is not a symptom known by the driver, in addition to stopping the car, he should also ask for help.
• With apparently non-significant chest pain, do not drive, nor attempt to go driving to the emergency room. Wait until it disappears and, otherwise, ask for help.
• The drugs sometimes used for esophageal motor disorders can have side effects that should be warned to the driver, so that he increases caution when driving.
• Driving should be not recommended if adverse reactions arise with the drugs reducing the ability of the driver.

Mallory-Weiss syndrome

Mallory-Weiss syndrome is characterized by laceration of the distal esophagus and of the proximal stomach, during episodes of vomiting, retching or hiccup.

It is evidenced as bleeding of arterial origin.

Most bleeding episodes subside spontaneously with rest, but others require direct hemostatic treatment.

The feeing of fullness in the throat is a subjective sensation of a lump or object in the throat, frequently associated with emotional disorders or anxiety.

The treatment is based on confirming that there is no responsible organic disease and on calming down the patient.

Depression, anxiety, and other underlying behavioral disorders should be treated, with psychiatric consultation if necessary.

Advice on Mallory-Weiss syndrome

• With active bleeding or unhealed gastroesophageal injury, the patient must not drive.
• The physician, in the event of a favorable evolution of the patient and after verifying the injuries, will indicate the time when the patient can drive again, and will report on it.

Halitosis

Halitosis does not interfere with driving, unless the drivers get nervous when there are other passengers in the car.

They drive with windows down, turning their head to the left in a forced position and permanently looking for mint candies or chewing-gums in the car.

This situation frequently causes lack of attention from distraction and anxiety with the risk of causing an accident.

Furthermore, driving in a forced position decreases the visual field and the control of environment.

The removal or treatment of the specific causes is effective. Many cases are imaginary or psychogenic halitosis associated with anxiety, that require specific treatment.

Should we institute medical therapy with anxiolytics, we should warn about the risk of somnolence of these drugs, that interfere adversely with driving.

Advice on feeing of fullness

• This feeling does not interfere with driving by itself, but frequently the associated psychiatric disorders and their treatment indeed hinder it.
• The physician will warn the patient of the side effects of the drugs, and if necessary for the emotional symptoms of the patient, will advise against driving until clinical improvement.