Dysphagia: Difference between revisions

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==Background==
==Background==
*Most pts w/ dysphagia have an identifiable, organic cause
[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
*Assume malignancy in pts >40yo with new-onset dysphagia
[[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
*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


==Diagnosis==
==Clinical Features==
''Must distinguish between transfer dysphagia and transport dysphagia''
*Difficulty swallowing
*Sensation of food stuck
*[[Chest pain]]
*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)
**Esophageal dysphagia
***Mechanical obstruction - usually solid food only
***Neuromuscular disorder - solid or liquid food


===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)====
====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, MG, Parkinson's, botulism, lead poisoning
***[[CVA]], [[scleroderma]], [[myasthenia gravis]], [[parkinson's disease|Parkinson's]], [[botulism]], [[lead poisoning]]
**Localized disease
**Localized disease
***Pharyngitis, aphthous ulcers, PTA, Zenker diverticulum
***[[Pharyngitis]], aphthous ulcers, [[PTA]], [[zenker's diverticulum|Zenker diverticulum]]
*Symptoms
*Symptoms
**Gagging, coughing, inability to initiate swallow, need for repeated swallows
**Gagging, [[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)
***Foreign body, carcinoma, webs, stricures, thyroid enlargement
***[[ingested foreign body|Foreign body]], carcinoma, webs, strictures, [[thyroid]] enlargement
**Motor disorder
**Motor disorder
***Achalasia, peristaltic dysfunction (nutcracker esophagus), scleroderma
***[[Achalasia]], peristaltic dysfunction (nutcracker esophagus), [[scleroderma]]
*Symptoms
*Symptoms
**Food "sticking," retrosternal fullness w/ solids (and eventually liquids), odynophagia
**Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia
 
==Differential Diagnosis==
{{Dysphagia DDX}}


==Treatment==
==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
*Referral to GI or ENT for direct laryngoscopy or video-esophagography


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==References==
==References==
 
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Symptoms]]

Latest revision as of 22:24, 7 February 2024

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.
Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.
Esophagus anatomy and nomenclature based on two systems.
  • 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)

Transport dysphagia (esophageal)

  • Improper transfer of bolus from upper esophagus into stomach
  • Etiology
  • Symptoms
    • Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia

Differential Diagnosis

Dysphagia

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

  1. ↑ Spieker MR. Evaluating Dysphagia. Am Fam Physician. 2000 Jun 15;61(12):3639-3648.
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