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:
- Myasthenia gravis
- Myotonia dystrophica
Pharyngeal dysfunction:
- Myasthenia gravis
- Vascular brain stem disease including bulbar and pseudobulbar palsy and syringobulbia.
- Dermatomyositis
- Hyperthyroidism
1.2. Obstructive
Dysphagia mainly to solids
- Zenker diverticulum
- Systemic sclerosis
- Tumor
- Inflammatory stricture
2. Esophageal Dysphagia
Accompanied by emptying of the mouth
1. Functional
Dysphagia to solids & fluids
Motility disorders (accompanied by regurgitation):
- Diffuse oesophageal spasm (intermittent dysphagia)
- Achalasia
- Scleroderma (progressive)
- Diabetic neuropathy
- Amyloidosis
- Chagas disease
2. Obstructive
Dysphagia mainly to solids
1.Intraluminal obstruction:
- Lower oesophageal ring, web (intermittent)
- Peptic stricture, caustic stricture (progressive)
- Carcinoma (progressive)
2. Extraluminal obstruction:
- tumor
- Lymph node enlargement
- substernal thyroid
- vascular anomalies (aortic aneurysm)
