Dysphagia

Question 1

What should you think when someone presents with dysphagia?

Answer 1

• Upper GI malignancy until proven otherwise
• Urgent upper GI endoscopy 1st line

Question 2

Two categories of dysphagia causes

Answer 2

Mechanical or motility problem

Question 3

Mechanical causes of dysphagia

Answer 3

• Oesophageal, gastric or head and neck cancer
• Benign oesophageal strictures
• Extrinsic compression (eg goitre)
• Pharyngeal pouch
• Foreign body - children mainly
• Oesophageal web

Question 4

Motility causes of dysphagia

Answer 4

• Stroke/TIA
• Achalasia
• Diffuse oesophageal spasm
• Myasthenia gravis
• Muscular dystrophy

Question 5

Questions to ask re dysphagia

Answer 5

• Duration
• Frequency
• Difficulty initiating the swallow?
• Cough after swallowing?
• Do you have to swallow a few times to get food to pass to your throat?

Question 6

Other symptoms to ask about if presenting with dysphagia

Answer 6

• Reflux
• Dyspepsia
• Hoarse voice
• Referred pain - to neck or ear
• Weight loss
• Odonophagia - be sure to differentiate

Question 7

Examining someone presenting with dysphagia?

Answer 7

• Motor dysfunction
• Resting tremor
• Dysarthria
  = neuromuscular cause picture
• Examine mouth for oral disease
• Neck lymphadenopathy?
• Abdomen - masses?

Question 8

Bedside and bloods for dysphagia presentation

Answer 8

• FBC - anaemia, are they bleeding? Acute infectious cause?
• LFT - varices or ascites
• TFTs - goitre cause

Question 9

Imaging for dysphagia

Answer 9

• Upper GI endoscopy
• Allows assessment for mechanical cause and excludes upper GI malignancy

Question 10

Investigations if normal OGD and symptoms persist so suspect motility problem

Answer 10

• Manometry testing
• = assess motor function of upper oesophageal sphincter, oesophageal body and lower oesophageal sphincter

Question 11

Management dysphagia

Answer 11

• Treat cause
• Consider nutritional status - dietician involved if malnourished
• Speech and language therapist if motility problem