Dysphagia
Overview
Dysphagia refers to difficulty swallowing; this may be caused by pathology affecting the mouth, oropharynx, or oesophagus. The particulars of the difficulty swallowing and particularly the timing of the difficulty within the swallow can aid in narrowing down the cause.
Ask About
- Difficulty swallowing
- Sensation of food stuck in throat
- Swallowing more than once to get a bite down
- Coughing with meals
- Regurgitating food
Aetiology
Causes of Dysphagia
Oral Cavity
- Poor dentition
- Tumour
- Trauma
- Xerostomia - Sjögren's, antihistamines, antipsychotics, diuretics, radiation, mouth breathing, dehydration, diabetes, alpha blockers, ACEis, ATII blockers, opiates
- Amyloidosis of the tongue
Oropharyngeal
- Tumour
- Stenosis - radiation, surgery, chemical irritation
- Infection - viral / bacterial
- Extrinsic compression - cervical lymphadenopathy, thyroid enlargement
- Neurological - stroke, Parkinson's, ALS, MS, CNS tumour, TBI, Alzheimer's, cerebral palsy
- Neuromuscular - myasthenia gravis, muscular dystrophy, inflammatory myopathies
- Trauma - blunt, penetrating, extrinsic compression from swelling
- Zenker's diverticulum
Oesophageal
- Foreign body
- Tumour - oesophageal carcinoma, metastasis
- Extrinsic compression - mediastinal / lung mass, cervical osteophytes
- Stricture - reflux, chemical irritation (potassium, NSAIDS, alendronate, antibiotics), radiation
- Inflammation - erosive oesophagitis, eosinophilic oesophagitis
- Neuromuscular - achalasia, scleroderma, oesophageal spasm, inflammatory myopathies
- Hiatus hernia
- Oesophageal ring
- Oesophageal web
Other
- Psychogenic dysphagia
History of Presenting Complaint
Onset
Whether the dysphagia began suddenly or gradually, and in what situation.- Sudden onsetSuggestive of obstruction or oesophagitis
- Progressive dysphagiaSuggestive of neuromuscular cause
Type of Food
Whether the dysphagia is worse with certain foods.- Dysphagia of solids onlySuggestive of mechanical cause
- Dysphagia of solids and liquidsSuggestive of neuromuscular cause
- Dysphagia of cold foodsSuggestive of neuromuscular cause
Phase of Swallow
What part of swallowing the patient has difficulty with.- Difficulty initiating swallowSuggestive or oral or oropharyngeal cause
- Sensation of food stuck in throatSuggestive of oesophageal cause
Coughing During Meals
Whether the patient coughs during or after swallowing.- Coughing early in swallowSuggestive of neuromuscular cause
- Coughing late in swallowSuggestive of obstructive cause
Regurgitation
Whether food comes back up after meals.- Regurgitation of foodMay be indicative of achalasia
- Regurgitation of old foodMay be indicative of Zenker's diverticulum
Associated Symptoms
Whether the dysphagia is associated with any other symptoms.- Muscular weaknessSuggestive of neuromuscular cause
- HalitosisSuggestive of Zenker's diverticulum
- HeartburnSuggestive of hiatus hernia, reflux or eosinophilic oesophagitis
- Weight lossRed flag for malignancy
Alleviating Factors
Whether there is anything that improves the dysphagia.- Relieved with repeated swallowingSuggestive of foreign body or achalasia
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