Dysphagia: Difference between revisions
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==Background== | ==Background== | ||
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | |||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | |||
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]] | |||
*Most patients with dysphagia have an identifiable, organic cause | *Most patients with dysphagia have an identifiable, organic cause | ||
*Assume malignancy in patients >40yo with new-onset dysphagia | *Assume malignancy in patients >40yo with new-onset dysphagia | ||
*Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone. | *Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone. | ||
*CVA is most common cause of oropharyngeal dysphagia | *CVA is most common cause of oropharyngeal dysphagia | ||
==Clinical Features== | ==Clinical Features== | ||
*Difficulty swallowing | *Difficulty swallowing | ||
*Sensation of food stuck | *Sensation of food stuck | ||
*[[Chest pain]] | *[[Special:MyLanguage/Chest pain|Chest pain]] | ||
*Dysphagia categories<ref>Spieker MR. Evaluating Dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-3648.</ref> | *Dysphagia categories<ref>Spieker MR. Evaluating Dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-3648.</ref> | ||
**Oropharyngeal dysphagia - difficulty initiating swallowing (coughing, chocking, nasal regurgitation) | **Oropharyngeal dysphagia - difficulty initiating swallowing (coughing, chocking, nasal regurgitation) | ||
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***Mechanical obstruction - usually solid food only | ***Mechanical obstruction - usually solid food only | ||
***Neuromuscular disorder - solid or liquid food | ***Neuromuscular disorder - solid or liquid food | ||
====Transfer dysphagia (oropharyngeal)==== | ====Transfer dysphagia (oropharyngeal)==== | ||
*Discoordination in transferring bolus from pharynx to esophagus | *Discoordination in transferring bolus from pharynx to esophagus | ||
*Etiology | *Etiology | ||
**Neuromuscular disease (80% of cases) | **Neuromuscular disease (80% of cases) | ||
***[[CVA]], [[scleroderma]], [[myasthenia]], [[parkinson's disease|Parkinson's]], [[botulism]], [[lead poisoning]] | ***[[Special:MyLanguage/CVA|CVA]], [[Special:MyLanguage/scleroderma|scleroderma]], [[Special:MyLanguage/myasthenia gravis|myasthenia gravis]], [[Special:MyLanguage/parkinson's disease|Parkinson's]], [[Special:MyLanguage/botulism|botulism]], [[Special:MyLanguage/lead poisoning|lead poisoning]] | ||
**Localized disease | **Localized disease | ||
***[[Pharyngitis]], aphthous ulcers, [[PTA]], [[zenker's diverticulum|Zenker diverticulum]] | ***[[Special:MyLanguage/Pharyngitis|Pharyngitis]], aphthous ulcers, [[Special:MyLanguage/PTA|PTA]], [[Special:MyLanguage/zenker's diverticulum|Zenker diverticulum]] | ||
*Symptoms | *Symptoms | ||
**Gagging, [[cough]]ing, inability to initiate swallow, need for repeated swallows | **Gagging, [[Special:MyLanguage/cough|cough]]ing, inability to initiate swallow, need for repeated swallows | ||
====Transport dysphagia (esophageal)==== | ====Transport dysphagia (esophageal)==== | ||
*Improper transfer of bolus from upper esophagus into stomach | *Improper transfer of bolus from upper esophagus into stomach | ||
*Etiology | *Etiology | ||
**Obstructive disease (85% of cases) | **Obstructive disease (85% of cases) | ||
***[[ingested foreign body|Foreign body]], carcinoma, webs, strictures, [[thyroid]] enlargement | ***[[Special:MyLanguage/ingested foreign body|Foreign body]], carcinoma, webs, strictures, [[Special:MyLanguage/thyroid|thyroid]] enlargement | ||
**Motor disorder | **Motor disorder | ||
***[[Achalasia]], peristaltic dysfunction (nutcracker esophagus), [[scleroderma]] | ***[[Special:MyLanguage/Achalasia|Achalasia]], peristaltic dysfunction (nutcracker esophagus), [[Special:MyLanguage/scleroderma|scleroderma]] | ||
*Symptoms | *Symptoms | ||
**Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia | **Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Dysphagia DDX}} | {{Dysphagia DDX}} | ||
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==Evaluation== | ==Evaluation== | ||
*Evaluate for underlying etiology (e.g. rule out new neuro dysfunction) | *Evaluate for underlying etiology (e.g. rule out new neuro dysfunction) | ||
*Neck x-ray (AP and lateral) | *Neck x-ray (AP and lateral) | ||
**Helpful in presumed transfer dysphagia and proximal transport dysphagia | **Helpful in presumed transfer dysphagia and proximal transport dysphagia | ||
*[[CXR]] | *[[Special:MyLanguage/CXR|CXR]] | ||
**Helpful in presumed transport dysphagia | **Helpful in presumed transport dysphagia | ||
==Management== | ==Management== | ||
*Referral to GI or ENT for direct laryngoscopy or video-esophagography | *Referral to GI or ENT for direct laryngoscopy or video-esophagography | ||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Symptoms]] | |||
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Latest revision as of 22:50, 4 January 2026
Background
- Most patients with dysphagia have an identifiable, organic cause
- Assume malignancy in patients >40yo with new-onset dysphagia
- Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone.
- CVA is most common cause of oropharyngeal dysphagia
Clinical Features
- Difficulty swallowing
- Sensation of food stuck
- Chest pain
- Dysphagia categories[1]
- Oropharyngeal dysphagia - difficulty initiating swallowing (coughing, chocking, nasal regurgitation)
- Esophageal dysphagia
- Mechanical obstruction - usually solid food only
- Neuromuscular disorder - solid or liquid food
Transfer dysphagia (oropharyngeal)
- Discoordination in transferring bolus from pharynx to esophagus
- Etiology
- Neuromuscular disease (80% of cases)
- Localized disease
- Pharyngitis, aphthous ulcers, PTA, Zenker diverticulum
- 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, strictures, 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
Differential Diagnosis
Dysphagia
- Oropharyngeal dysphagia
- CVA
- Parkinson's disease
- Brain stem tumors
- Degenerative disease - ALS, MS, Huntington's
- Postinfectious - polio, syphilis
- Peripheral neuropathy
- Myasthenia gravis
- Polymyositis, dermatomyositis
- Muscular dystrophy
- Esophageal dysphagia
- Achalasia
- Diffuse esophageal spasm
- Ingested foreign body
- Esophageal web
- Malignancy, mediastinal masses
- Schatzki Ring
- Scleroderma
- Strictures - peptic, radiation, chemical, medication-induced
- Vascular compression
- Zenker's diverticulum
Evaluation
- Evaluate for underlying etiology (e.g. rule out new neuro dysfunction)
- Neck x-ray (AP and lateral)
- Helpful in presumed transfer dysphagia and proximal transport dysphagia
- CXR
- Helpful in presumed transport dysphagia
Management
- Referral to GI or ENT for direct laryngoscopy or video-esophagography
Disposition
See Also
References
- ↑ Spieker MR. Evaluating Dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-3648.