Dysphagia/Odynophagia
(Gastroenterology. 1999;117:229-32 & 233-54)
DEFINITION:
Difficulty swallowing and passing food from the mouth or esophagus to the stomach
Divided into: Oropharyngeal or Esophageal (See Etiologies below)
Globus (hystericus): feeling of lump in throat; Not to be confused with dysphagia
Not related to swallowing, present continually and may be temporarily alleviated during swallowing
Dysphagia Lusoria (Lusoria = trick of nature): impingement of aberrant vasculature on proximal esophagus
Most common type involves an aberrant right subclavian artery and compresses the esophagus
Diagnosis: MRI is believed to be most accurate in defining lesion; Also should have manometry and barium swallow to confirm
ETIOLOGIES:
Causes of Esophageal Dysphagia:
Solids (Mechanical Obstruction): RPC
INTERMITTENT » Ring See also Esophagus/Gastric- Schatzki’s Ring (Chapter 1.22)
PROGRESSIVE/GERD » Peptic stricture (Simple: <2 cm, focal, nonangulated)
(Complex >2 cm, angulated, severe narrowing)
PROGRESSIVE » Cancer (pseudoachalasia)
Solids & Liquids (Motility): SSA
INTERMITTENT » Spasm
PROGRESSIVE/GERD » Scleroderma
PROGRESSIVE » Achalasia
Causes of Oropharyngeal Dysphagia: problems with initiating swallowing (Gastroenterology 1999; 116:452-54 & 455-78)
Propulsive:
Neurologic (CVA, Parkinson’s, ALS, Multiple Sclerosis, Brain cancer)
Muscular (Muscular Dystrophy, Dermatomyositis, Poliomyelitis, Myasthenia gravis): ↑ Creatine Kinase/Aldolase
Autoimmune (SLE, Sarcoid, Amyloid)
(Note: Stroke patients usually take 2 weeks to improve, if none after that time, then swallowing function should be evaluated)
Structural: Neoplasm, Cricopharyngeal bars, Zenker’s, Lymphadenopathy, Cervical osteophytes, Infections, Oral CD, Behçet’s, Dentition
Cricopharyngeal bar: indentation of the cricopharyngeal muscle seen as barium passes by slowly and the muscle poorly relaxes
Can be the sole cause of oropharanygeal dysphagia but other neuromuscular diseases should be excluded
Iatrogenic: Oropharnygeal resections, Mucositis due to chemo, Radiation-induced, Neck stabilizations (hardware, halo), Dental prostheses
Other:
Zenker’s (diverticula that can occur throughout hypopharynx); See also Esophagus/Gastric-Diverticula of Esophagus (Chapter 1.03)Related posts:
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