Dysphagia: Difference between revisions
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***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, | ***[[CVA]], [[scleroderma]], [[myasthenia]], [[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, | **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, | ***[[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 with solids (and eventually liquids), odynophagia | **Food "sticking," retrosternal fullness with solids (and eventually liquids), odynophagia | ||
==Differential Diagnosis== | |||
{{Dysphagia DDX}} | |||
==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== | ==Management== | ||
Revision as of 20:29, 29 September 2019
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.