Associated symptoms

Question 1

Dysphagia duration of symptoms?

Answer 1

A stuck food bolus will appear during a meal, cancer presents with a short history of days to weeks, chronic motility disorders such as achalasia present with symptoms lasting months to years.

Question 2

Dysphagia progressive or intermittent?

Answer 2

Progressive suggests a stricture, intermittent are motility disorders.

Question 3

Dysphagia to solids liquids or both?

Answer 3

More for solids is likely mechanical i.e. stricture, if more for liquids suggests motility disorder. Absolute dysphagia to solids, liquids and saliva is typical of a food bolus, but an underlying stricture or malignancy will cause food to get repeatedly stuck.

Question 4

Dysphagia is there coughing, if so is it related to eating?

Answer 4

Coughing immediately after swallowing (i.e. choking) suggests a problem with the coordination of swallowing events stroke or Parkinson’s likely. If coughing occurs some time after a meal, this indicates that food is being regurgitated. This could be due to food retained in a pharyngeal pouch, aspiration of food remaining in a dilated oesophagus or GORD. Nocturnal cough when patients are lying flat and not eating is suggestive of achalasia.

Question 5

Dysphagia do they suffer with halitosis?

Answer 5

When food remains lodged in the pharyngeal pouch in the oropharynx.

Question 6

Dysphagia is there gurgling?

Answer 6

pharyngeal pouch make gurgling noises if they attempt to speak soon after eating/drinking.

Question 7

Dysphagia dysphonia, hoarseness?

Answer 7

vocal cord dysfunction due to involvement of the recurrent laryngeal nerve (e.g. compression by tumour).

Question 8

Dysphagia heartburn or waterbrash?

Answer 8

GORD

Question 9

Dysphagia weight loss?

Answer 9

Red flag for oesophageal cancer, although mild weight loss can be due to eating less due to pain.

Question 10

Dysphagia neurological symptoms?

Answer 10

if a patient has features suggestive of functional dysphagia (e.g. problems coordinating the swallow).

Question 11

Dysphagia rheumatological symptoms?

Answer 11

important if limited cutaneous systemic sclerosis is suspected, it is also known as CREST; calcinosis, Raynauds phenomenon, Oesophageal dysmotility, sclerodactly, telangiectasia.