Dysphagia

Question 1

A patient presents with dysphagia. How might you structure the history?

Answer 1

• What level?
• Timecourse (sudden, chronic, intermittent)
• Solids and/or liquids?
• Associated symptoms
  
  • Weight loss
  • Pain
  • Long term reflux
  • Aspiration
  • Regurgitation
• PHx
  
  • Reflux, CVA, neurological disorders, scleroderma

Question 2

What might be pertinent investigations in a patient with dysphagia with a view to making a diagnosis?

Answer 2

• Oropharyngeal
  
  • Video swallow
• Oesophageal
  
  • Gastroscopy
  • Barium swallow (useful for achalasia, pharyngeal pouch)
  • CT scan (useful for hiatus hernia assessment, malignancy)
  • Oesophageal manometry (useful for achalasia, spasm)