Dysphagia - Oropharyngeal & Esophageal Dysphagia (Causes/Differential Diagnosis, Signs, Treatment)

Summary

Dysphagia, 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.