Dysphagia or difficulty in swallowing usually indicates organic disease. It differs from odynophagia (pain on swallowing). The history should establish duration, the constant or intermittent nature, and whether it is worse with solids or liquids. If solids are affected more than liquids, the cause is more likely to be obstruction, whereas liquids are affected more in neurological disease. Odynophagia that occurs with liquids suggests upper oesophageal ulceration. Pharyngeal problems are suggested by difficulty in initiating the swallow, or regurgitation into the nose, whereas oesophageal obstruction may manifest with food sticking retrosternally. Causes are as follows:
· Intraluminal blockage from the presence of a foreign body.
· Intramural dysphagia resulting from pharyngitis, tonsillitis, candidiasis, oesophageal web, benign strictures, carcinoma, achalasia or myasthenia gravis.
· Extrinsic compression from thyroid enlargement, pharyngeal pouch, mediastinal lymph node enlargement, aortic aneurysm or paraesophageal hernia.
Investigations that may be useful include videofluoroscopy, contrast swallow, upper gastrointestinal endoscopy and chest imaging. See also under individual conditions.