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Dysphagia

Approach

  • Be conscious of the possible serious pathologies

Vital points

  • Difficulty swallowing liquids, solids or both
  • Onset?
  • Regurgitation?
  • Can you eath a full meal?
  • Weight loss?

Causes of dysphagia

Mechanical Obstruction Co-ordination abnormalities
  1. Within the lumen
    • Foreign body
    • Oesophageal web (scleroderma)
    • Plummer-Vinson syndrome
  2. In the wall
    • Carcinoma of the oesophaguys
    • Oesophagitis (due to burns or chronic reflux)
    • Barrett's oesophagus
    • Benign oesophagus stricture
    • Post-radiation strictures
  3. Outside the wall
    • Retrosternal goitre
    • Lung carcinoma
    • Pharyngeal pouch
  1. Motility disorders
    • Oesophageal spasm
    • Achalasia
  2. Neurological disease
    • Myasthenia gravis
    • Bulbar palsy (including MND)
    • Cerebrovascular accidents 

 

Investigations

  1. Barium swallow
  2. Endoscopy 

 

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