Dysphagia

Question 1

Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

Answer 1

Oesophageal cancer

Question 2

May be history of heartburn
Odynophagia (painful swallowing) but no weight loss and systemically well

Answer 2

oesophagitis

Question 3

There may be a history of HIV or other risk factors such as steroid inhaler use

Answer 3

Oesophageal candidiasis

Question 4

Dysphagia of both liquids and solids from the start

• *Heartburn**
• *Regurgitation of food** - may lead to cough, aspiration pneumonia etc

Answer 4

Achalasia

(muscles of the lower part of the oesophagus fail to relax)

Question 5

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen

Answer 5

Pharyngeal pouch

Question 6

May have additional features of Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia

Answer 6

Systemic sclerosis

(CREST)

Question 7

Dysphagia with extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids

Answer 7

Myasthenia gravis

Question 8

May be history of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further investigation for organic causes.

Answer 8

Globus hystericus

Question 9

A 54-year-old man presents with a 3 month history of ‘heartburn’. He has noticed that swallowing is painful, particularly when he eats meat or bread. After eating and at night he has an ‘unpleasant’ retrosternal sensation. Clinical examination is unremarkable
What is causing it?

Answer 9

Oesophagitis

Question 10

A 67-year-old woman presents with a 5 week history of food getting stuck. She is currently treated for COPD and was recently noted to have a macrocytosis on routine bloods. On a number of occasions she has vomited during the meal and says she has no taste for food any more.

What is causing it?

Answer 10

Oesophagesal cancer

Question 11

A 43-year-old woman with a history of anxiety complains of problems swallowing. On examination she is noted to have a number of small white lumps on her hands and telangiectasia on her face.

What is causing it?

Answer 11

Systemic sclerosis