Dysphagia

Question 1

What should you immediately suspect in dysphagia?

Answer 1

Oesophageal cancer

Question 2

What is dysphagia? Odonyphagia?

Answer 2

Difficulty swallowing

Pain on swallowing

Question 3

What are the causes of dysphagia?

Answer 3

Mechanical:
Oesophageal or gastric malignancy
Benign oesophageal strictures
Extrinsic compression
Pharyngeal pouch
Foreign body

Neuromuscular:
Post-stroke
Achalasia
Diffuse oesophageal spasm
Myasthenia graves
Myotonic dystrophy

Question 4

What is achalasia

Answer 4

Failure of smooth muscle fibres in lower oesophageal sphincter to relax so it remains closed.

Question 5

What questions should you ask in dysphagia?

Answer 5

Difficulty initiating the swallow action
Cough after swallowing
Swallow a few times to get food past throat
Difficulty vs pain
Regurgitation?
sEnsation of food tuck?
Horse voice?
Weight loss?
Referred ear/neck pain?

Question 6

What investigations for dysphagia?

Answer 6

Endoscopy ± biopsy to exclude malignancy
Routine bloods
Barium swallow for pharyngeal pouch or other diverticulum

Question 7

Describe the cancer referral pathway

Answer 7

Urgent upper GI endoscopy 2 week wait for people with dysphagia aged 55 or over with weight loss plus:
Upper abdo pain
Reflux
Dyspepsia

Non-urgent referral with haematemesis of 55 years or over with treatment resistant dyspepsia or upper abdomen pain