Dysphagia

Dysphagia

• is difficulty in swallowing food or liquid
  • cause may be local or systemic.
• is common, especially in old age
• should be distinguished from the following two conditions
  • odynophagia : painful swallowing (frequently associated with dysphagia)
  • globus : sensation of a mass in the throat
• can be grouped as :
  • oropharyngeal dysphagia
    • abnormalities of the initiation of swallowing reflex in the oropharynx
    • common in old age
    • commonest cause is stroke
  • oesophageal dysphagia
    • abnormalities of flow of the food bolus through the esophagus into the stomach
    • causes include:
      • achalasia, scleroderma,carcinomas, strictures

Key points (2):

• new onset dysphagia in adults requires urgent direct access upper gastrointestinal endoscopy (to be done within two weeks); dysphagia associated with head and neck cancer red flags requires a suspected head and neck cancer pathway referral
• in many cases malignancy is not found, but management of benign conditions, such as oesophageal dysmotility or gastro-oesophageal reflux, can be challenging
• secondary sequelae of benign and malignant dysphagia include malnutrition and aspiration pneumonia: consider early input from dietetic and speech and language therapy teams

Reference:

• (1) Spieker MR et al. Evaluating Dysphagia, American Family Physician 2000; 61(12)
• (2) Waters A, Patterson J, Bhat P, , Phillips A. Investigating dysphagia in adults: symptoms and tests BMJ 2022; 379 :e067347 doi:10.1136/bmj-2021-067347