Dysphagia

Background

• Most pts w/ dysphagia have an identifiable, organic cause
• Assume malignancy in pts >40yo with new-onset dysphagia

Diagnosis

• Must distinguish between transfer dysphagia and transport dysphagia

Transfer dysphagia (oropharyngeal)

• Discoordination in transferring bolus from pharynx to esophagus
• Etiology
  • Neuromuscular disease accounts for 80% of cases
    • CVA, scleroderma, MG, Parkinson's, botulism, lead poisoning
• 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 accounts for 85% of cases
    • Foreign body, carcinoma, webs, stricures, thyroid enlargement
• Symptoms
  • Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia

Work-Up

• Neck x-ray (AP and lateral)
  • Helpful in presumed transfer dysphagia and proximal transport dysphagia
• CXR
  • Helpful in presumed transport dysphagia

Treatment

• Referral to GI or ENT for direct laryngoscopy or video-esophagography

Source

Tintinalli