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Dysphagia
From WikEM
Contents
Background
- Most patients with dysphagia have an identifiable, organic cause
- Assume malignancy in patients >40yo with new-onset dysphagia
Clinical Features
- Difficulty swallowing
- Sensation of food stuck
- Chest pain
Differential Diagnosis
Dysphagia
- Achalasia
- Esophageal foreign body
- Schatzki Ring
- Esophageal web
Evaluation
Must distinguish between transfer dysphagia and transport dysphagia
Work-Up
- Neck x-ray (AP and lateral)
- Helpful in presumed transfer dysphagia and proximal transport dysphagia
- CXR
- Helpful in presumed transport dysphagia
Evaluation
Transfer dysphagia (oropharyngeal)
- Discoordination in transferring bolus from pharynx to esophagus
- Etiology
- Neuromuscular disease (80% of cases)
- CVA, scleroderma, MG, Parkinson's, botulism, lead poisoning
- Localized disease
- Pharyngitis, aphthous ulcers, PTA, Zenker diverticulum
- Neuromuscular disease (80% of cases)
- Symptoms
- Gagging, coughing, inability to initiate swallow, need for repeated swallows
Transport dysphagia (esophageal)
- Improper transfer of bolus from upper esophagus into stomach
- Etiology
- Obstructive disease (85% of cases)
- Foreign body, carcinoma, webs, stricures, thyroid enlargement
- Motor disorder
- Achalasia, peristaltic dysfunction (nutcracker esophagus), scleroderma
- Obstructive disease (85% of cases)
- Symptoms
- Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia
Management
- Referral to GI or ENT for direct laryngoscopy or video-esophagography
