Dysphagia

Question 0

Causes

a. Oral phase dysphagia
b. Pharyngeal phase dysphagia
c. Oropharyngeal dysphagia

Answer 0

a. Oral phase dysphagia
- poor bolus formation and control

b. Pharyngeal phase dysphagia
- poor tongue or paryngeal propulsion
- UES obstruction
* SSX: hoarseness and CN dysfunction

c. Oropharyngeal dysphagia
neurologic, muscular, structural, iatrogenic, infectious, and metabolic

Iatrogenic: surgery and radiation of head and neck
Neurogenic: cerebrovascular accidents, Parkinson’s disease, and amyotrophic lateral sclerosis
Structural: Zenker’s diverticulum, cricopharyngeal bar, and neoplasia

Question 1

Differentiate

a. dysphagia
b. aphagia
c. odynophagia
d. globus pharyngis
e. transfer dysphagia
f. phagophobia

Answer 1

Dysphagia—difficulty with swallowing—refers to problems with the transit of food or liquid from the mouth to the hypopharynx or through the esophagus. Severe dysphagia can compromise nutrition, cause aspiration, and reduce quality of life.

Aphagia denotes complete esophageal obstruction, most commonly encountered in the acute setting of a food bolus or foreign body impaction.

Odynophagia refers to painful swallowing, typically resulting from mucosal ulceration within the oropharynx or esophagus. It commonly is accompanied by dysphagia, but the converse is not true.

Globus pharyngeus is a foreign body sensation localized in the neck that does not interfere with swallowing and sometimes is relieved by swallowing.

Transfer dysphagia frequently results in nasal regurgitation and pulmonary aspiration during swallowing and is characteristic of oropharyngeal dysphagia.

Phagophobia (fear of swallowing) and refusal to swallow may be psychogenic or related to anticipatory anxiety about food bolus obstruction, odynophagia, or aspiration.

Question 2

Causes of esophageal dysphagia (structural and propulsive )

Answer 2

a. Structural
- Schatzki’s rings, eosinophilic esophagitis, and peptic strictures.

b. Propulsive
- abnormalities of peristalsis and/or deglutitive inhibition, potentially affecting the cervical or thoracic esophagus

Question 3

Differentiate

a. achalasia
b. diffuse esophageal spasm (DES)
c. scleroderma

Answer 3

Absent peristalsis and failure of deglutitive LES relaxation are the defining features of achalasia.

In diffuse esophageal spasm (DES), LES function is normal, with the disordered motility restricted to the esophageal body.

Absent peristalsis combined with severe weakness of the LES is a nonspecific pattern commonly found in patients with scleroderma.