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Category: Family Medicine | Gastroenterology

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Dysphagia overview

Published: January 13, 2016. Updated: October 24, 2016

 

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Dysphagia is the nonpainful difficulty in swallowing. It is most probably experienced at the same level as the lesion or above it.

Dysphagia should differentiated from odynophagia (is the term applied to painful swallowing) as well as from globus hystericus (a sensation of a lump in the throat & is not associated with deglutition or regurge).

Warning signs

Age above 50 years, weight loss, hematemesis are concerning for malignancy. As is progressive dysphagia that presents more to solids than liquids.

1. Oropharyngeal dysphagia

Not accompanied by emptying of the mouth. Usually involves aspiration of liquids (more than solids) leading to cough. Video fluoroscopy can help confirm the diagnosis.

1.1. Functional

Dysphagia to solids and liquids.

Loss of tongue function:

Pharyngeal dysfunction:

     
  • Myasthenia gravis
  •  
  • Vascular brain stem disease including bulbar and pseudobulbar palsy and syringobulbia.
  •  
  • Dermatomyositis
  •  
  • Hyperthyroidism

1.2. Obstructive

Dysphagia mainly to solids

2. Esophageal Dysphagia

Accompanied by emptying of the mouth

1. Functional

Dysphagia to solids & fluids

Motility disorders (accompanied by regurgitation):

2. Obstructive

Dysphagia mainly to solids

1.Intraluminal obstruction:

     
  • Lower oesophageal ring, web (intermittent)
  •  
  • Peptic stricture, caustic stricture (progressive)
  •  
  • Carcinoma (progressive)

2. Extraluminal obstruction:


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