Dysphagia - Oropharyngeal & Esophageal Dysphagia (Causes/Differential Diagnosis, Signs, Treatment)
Summary
TLDRDysphagia, or difficulty swallowing, is categorized into oropharyngeal and esophageal types, with causes ranging from mechanical obstructions like tumors to neuromuscular issues such as post-stroke palsy. Symptoms can include aspiration, weight loss, and voice changes. Diagnosis involves endoscopy, barium swallow studies, and manometry. Treatment may involve stenting, speech therapy, or dietary modifications to manage symptoms without altering swallowing physiology.
Takeaways
- 🌟 Dysphagia refers to difficulty in swallowing, which can occur from the mouth to the stomach.
- 🔍 Dysphagia is categorized into oropharyngeal and esophageal dysphagia, each with mechanical or neuromuscular causes.
- 👅 Oropharyngeal causes include conditions like tonsillitis, stomatitis, and malignancy of the tongue.
- 🔎 Pharyngeal causes may involve foreign bodies, abscesses, Zenker's diverticulum, and malignancies or lymphadenopathy.
- 🩺 Neuromuscular causes for oropharyngeal dysphagia can include post-stroke conditions and bulbar palsy.
- 🌀 Esophageal causes encompass foreign bodies, strictures, scleroderma, Crohn's disease, atresia, hiatal hernias, and malignancies.
- 💊 Achalasia and myasthenia gravis are neuromuscular conditions affecting the esophagus and causing dysphagia.
- 🤒 Symptoms of dysphagia can manifest as difficulty swallowing solids, food or saliva control issues, aspiration, weight loss, and voice changes.
- 🏥 Endoscopic investigation and possibly biopsy are primary diagnostic tools for dysphagia, with barium swallow studies used when endoscopy is contraindicated.
- 📊 Additional tests include manometry to assess muscle and sphincter contractions and 24-hour pH monitoring for acid reflux.
- 🏥 Patients over 55 with dysphagia, weight loss, and specific symptoms should be referred for endoscopy promptly, while others may require non-urgent referral.
Q & A
What does dysphagia refer to?
-Dysphagia refers to a difficulty in swallowing, which can be perceived anywhere from the mouth to the stomach.
How is dysphagia classified?
-Dysphagia is classified into oropharyngeal dysphagia and esophageal dysphagia.
What are some mechanical causes of oropharyngeal dysphagia?
-Mechanical causes of oropharyngeal dysphagia include tonsillitis, stomatitis, malignancy of the tongue, foreign bodies, pharyngeal abscesses, and cervical lymphadenopathy.
What is Zenker's diverticulum and how is it related to dysphagia?
-Zenker's diverticulum is a pharyngeal pouch that can be a mechanical cause for oropharyngeal dysphagia.
What are the potential neuromuscular causes of dysphagia?
-Potential neuromuscular causes include post-stroke and bulbar palsy, achalasia, and myasthenia gravis.
What is achalasia and how does it present in dysphagia?
-Achalasia is a condition where the smooth muscle of the esophagus fails to relax, causing difficulty swallowing liquids and preventing swallowed content from passing easily into the stomach.
What is myasthenia gravis and how does it affect swallowing?
-Myasthenia gravis is a condition where antibodies target the nicotinic acetylcholine receptors at the neuromuscular junction, resulting in a lack of muscle contraction and difficulty swallowing solid foods.
What are the common symptoms of dysphagia?
-Common symptoms of dysphagia include difficulty controlling food or saliva in the mouth, aspiration (food or liquids going down the wrong way), weight loss, and voice changes after swallowing.
What is odynophagia and how is it related to dysphagia?
-Odynophagia means pain on swallowing and is suggestive of carcinoma but may also be caused by infections and inflammation.
What investigations are used to diagnose dysphagia?
-Endoscopic investigation is the primary tool used to investigate dysphagia, which may include a biopsy if lesions are suspected to be malignant. In some cases, a barium swallow study or manometry is performed.
What is the recommended referral process for patients with dysphagia who are aged 55 or above?
-Patients with dysphagia who are aged 55 or above, with weight loss and either upper abdominal pain, reflux, or dyspepsia should be referred for an endoscopy within two weeks.
How are mechanical and motility disorders of dysphagia managed?
-Mechanical issues may be managed with stenting or palliative referrals, while motility disorders are often seen by swallowing specialists or speech and language therapy teams, who may use techniques like altering food texture, postural techniques, or speech and language therapy exercises.
Outlines
🍽️ Dysphagia: Causes and Symptoms
Dysphagia refers to difficulty in swallowing, which can occur from the mouth to the stomach. It is categorized into oropharyngeal and esophageal dysphagia, each with mechanical or neuromuscular causes. Oropharyngeal dysphagia can be caused by conditions like tonsillitis, stomatitis, or malignancy of the tongue, while esophageal dysphagia may result from foreign bodies, strictures, or diseases like scleroderma. Neuromuscular causes include post-stroke issues and conditions like achalasia and myasthenia gravis. Dysphagia can present with symptoms such as difficulty swallowing solids, aspiration, weight loss, and voice changes. It can also be associated with odynophagia, which is painful swallowing.
Mindmap
Keywords
💡Dysphagia
💡Oropharyngeal dysphagia
💡Esophageal dysphagia
💡Mechanical causes
💡Neuromuscular causes
💡Achalasia
💡Myasthenia gravis
💡Odynophagia
💡Endoscopic investigation
💡Manometry
💡Speech and language therapy
Highlights
Dysphagia is difficulty in swallowing, perceived from the mouth to the stomach.
Dysphagia is divided into oropharyngeal and esophageal dysphagia.
Oropharyngeal dysphagia may have mechanical or neuromuscular causes.
Tonsillitis, stomatitis, and tongue malignancy are oropharyngeal causes.
Pharyngeal abscesses and zenka's diverticulum are pharyngeal causes.
Cervical lymphadenopathy can mechanically cause oropharyngeal dysphagia.
Post-stroke and bulbar palsy are neuromuscular causes of dysphagia.
Esophageal dysphagia can be caused by foreign bodies or strictures.
Esophageal atresia and hiatal hernia are developmental causes of dysphagia.
Malignancy, typically esophageal or gastric, can cause esophageal dysphagia.
Achalasia is a neuromuscular condition causing difficulty swallowing liquids.
Myasthenia gravis affects swallowing by targeting neuromuscular junction receptors.
Dysphagia symptoms include difficulty controlling food or saliva, and aspiration.
Odynophagia, pain on swallowing, suggests carcinoma or infections.
Endoscopic investigation is the primary tool for diagnosing dysphagia.
Barium swallow study is used when endoscopy is contraindicated.
Manometry measures esophageal muscle and sphincter contractions.
24-hour pH monitoring assesses stomach acid levels.
Patients with dysphagia over 55 with weight loss should be referred for endoscopy.
Mechanical issues may be treated with stenting or palliative care.
Motility disorders are managed by swallowing specialists or speech therapists.
Symptom relief procedures include food texture alteration and postural techniques.
Speech and language therapy exercises can change swallowing physiology.
Transcripts
dysphagia means a difficulty in
swallowing
which may be perceived anywhere from the
mouth to the stomach
it is grossly divided into oropharyngeal
dysphagia
and esophageal dysphagia which each
may have mechanical or neuromuscular
causes
oropharyngeal causes include tonsillitis
stomatitis and malignancy of the tongue
while pharyngeal causes may include
foreign bodies
pharyngeal abscesses or even a
pharyngeal pouch
known as zenka's diverticulum as well as
malignancies
of the wall or of the thyroid cervical
lymphadenopathy may also be a mechanical
cause
for oropharyngeal dysphagia a potential
neuromuscular cause includes post stroke
and bulbar palsy esophageal causes
can again include foreign bodies
strictures from esophagitis
radiotherapy scleroderma or crohn's
disease
and may also be caused by esophageal
atresia
which is the incomplete development of
the esophagus
another cause is a hiatal hernia and
malignancy
is also a cause here typically occurring
over time which may be esophageal or a
gastric malignancy
neuromuscular causes include acolasia
which is a condition
where the smooth muscle of the esophagus
fails to relax
in this instance the lower esophageal
sphincter
this means that swallowed content cannot
pass
easily into the stomach in contrast to
the norm in dysphagia
achalasia often presents with difficulty
with swallowing liquids
another condition is myasthenia gravis a
condition
where antibodies target the nicotinic
acetylcholine receptors
at the neuromuscular junction which
results in a lack of muscle contraction
this phager can manifest in several
different ways
the most common of which is difficulty
with swallowing
solid foods which is often described as
getting
stuck patients may refer that they have
difficulty in controlling
food or saliva in the mouth which may
manifest as dribbling
and they may also often have aspiration
meaning where food or liquids
go down the wrong way i.e into the lungs
resulting in coughing fits and
potentially pneumonia
other signs and symptoms include weight
loss
and voice changes after swallowing
another term related to dysphagia
is odinophagea which means pain on
swallowing
this is suggestive of carcinoma but may
also be caused by infections
and inflammation endoscopic
investigation
is the primary tool used to investigate
dysphagia
and the biopsy may be taken if the
lesions are thought to be
malignant in some instances an endoscopy
may be contraindicated
in these cases a barium swallow study
may be done
examples of which include zenka's
diverticulum which is easily ruptured
other investigations include manometry
which is where a tube
with pressure sensors is inserted into
the esophagus
to see how the muscle and sphincters are
contracting
24-hour ph monitoring may also be
included which measures
how much acid comes from the stomach in
a 24-hour period
patients who have dysphagia and are aged
55 or above
with weight loss and either upper
abdominal pain
reflux or dyspepsia should be referred
for an endoscopy within two weeks
non-urgently if they have hematomysis
or are aged 55 or above with upper
abdominal pain
or treatment resistant dyspeptia without
weight loss
mechanical issues may be stented or may
have a palliative referral
for stenting or even for chemotherapy on
the other hand
motility disorders will often be seen by
the swallowing specialists
or the speech and language therapy team
there are procedures done
to ease symptoms without changes to the
physiology of the swallow
which may include alteration of food
texture
postural techniques or even prosthetics
some techniques
do change the swallowing physiology such
as speech and language therapy exercises
and swallowing maneuvers
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