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