Dysphagia

Question 1

two categories of dysphagia

Answer 1

obstructive (mechanical) vs motility (neuromuscular)

oropharyngeal (initiation) vs esophageal (transport)

Question 2

next step after determining esophageal dysphagia

Answer 2

solid food only (obstruction) or solid and liquids (motility)

Question 3

likely Dx w/ intermittent, only food dysphagia

Answer 3

schatzki ring

Question 4

Dx w/ progressive food only and chronic heartburn, w/o weight loss

Answer 4

peptic stricture

Question 5

Dx w/ progressive, older age, only food, weight loss

Answer 5

carcinoma

Question 6

contrast barium swallow for peptic stricture and carcinoma

Answer 6

stricture will be smooth outline

carcinoma has rough edges, “apple core”

Question 7

Dx w/ solid or liquid, intermittent, w/ chest pain

Answer 7

diffuse esophageal spasm (corkscrew esophagus on barium)

Question 8

dx w/ solid or liquid, progresive w/ heartburn

Answer 8

scleroderma- atrophy of smooth muscle and LES

Question 9

dx w/ solid or liquid, progressive, bland regurg and weight loss

Answer 9

achalasia- loss of peristalsis and hypercontracted LES

Question 10

achalasia on barium swallow

Answer 10

“bird beak” w/ tight LES and dilated esophagus

Question 11

contrast scleroderma and achalasia

Answer 11

both are distal 2/3 aperstalsis

achalasia has tense LES, scleroderma is weak

scleroderma has GERD, achalasia doesnt

Question 12

eosinophilic esophagitis pres

Answer 12

solid only or solid and liquid

progressive

seen w/ edema rings and often w/ food impaction

Question 13

plummer vinson syndrome triad

Answer 13

dysphagia, iron deficiency, esophageal webs

Question 14

3 modalities for dysphagia testing

Answer 14

1. manometry- only functional, best for motility assessment
2. upper endoscopy- usually first, test structure and some motility, Dx and Tx (biopsy, dilation)
3. barium swallow- function and structure, not helpful w/ inflammation, no therapy