Dysphagia

Question 1

oropharyngeal vs. esophageal

Answer 1

mouth to esophagus vs. esophagus to stomach

Question 2

Presentation of oropopharyngeal dysphagia

1. initiating swallow
2. Structural
3. Neuromuscular

Answer 2

• difficulty inititiating swallow
• coughing/choking/aspiration

-Structural: abscess, Zenker diverticulum, tumor, post XRT

Neuromuscular (dementia, MG, parinson, stroke)

Question 3

Presentation fo esophageal dysphagia

Mechanical vs. motility

Answer 3

-sensation of food/liquid being “stuck”

Mechanical: solid > liquid; compression (tumor, ring, mediastinal mass, web)

Motility: solid and liquids affected equally (achalasia/scleroderma)

Question 4

Risk factors and history to consider

Answer 4

• COPD (think lung malignancy)
• XRT
• GERD (esophageal malignancy)
• hx of smoking/alcoholism
• allergy/asthma (eosinophilic esophagitis)
• Raynaud’s (scleroderma)
• alendronate/doxycycline/K supplement (pill esophagitis)

Question 5

testing for oropharyngeal dysphagia

Answer 5

Modified barium swallow (if normal move to EGD)

Question 6

testing for esophageal dysphagia

Answer 6

EGD

Question 7

when to refer

Answer 7

• oropharyngeal structural disease, consider ENT

- unless clearly OP dysphagia, referral to GI for endoscopy