Dysphagia

Question 1

What is dysphagia?

Answer 1

Difficulty swallowing (solids +/- liquids)

• can be either high or low in location
• can be either functional or structural in cause

Question 2

Functional causes of high dysphagia?

Answer 2

Stroke
Parkinson's 
Myasthenia gravies
MS
MND

Question 3

Functional causes of low dysphagia?

Answer 3

Achalasia
Oesophageal spasm
Limited cutaneous scleroderma (CREST)

Question 4

Structural causes of high dysphagia?

Answer 4

Cancer

Pharyngeal pouch

Question 5

Structural causes of low dysphagia?

Answer 5

Cancer
Stricture
Plummer-Vinson syndrome
Foreign body

Question 6

What is our biggest concern in patients with dysphagia?

Answer 6

Oesophageal cancer

- new-onset dysphagia in patients >55 is carcinoma until proven otherwise

Question 7

Investigations in dysphagia?

Answer 7

Barium swallow
Endoscopy
Videofluoroscopy
Manometry

Question 8

Reasons for barium swallow for investigating dysphagias?

Answer 8

High dysphagia - avoid perforation risk of endoscopy (cancer or pharyngeal pouch)
Low dysphagia - suspect achalasia or hiatus hernia

Question 9

Reasons for endoscopy for investigating dysphagia?

Answer 9

Low dysphagia - often first line (red flags present)

- most specific and sensitive

Question 10

Reasons for videofluoroscopy for investigating dysphagia?

Answer 10

High dysphagia - SALT can modify swallowing technique (more like a treatment), can diagnose functional or structural problem by confirming/ruling out functional swallowing problem/poor swallowing technique

Question 11

What is/reasons for manometry for investigating dysphagia?

Answer 11

Assesses pressure in LOS and wave of peristalsis in rest of oesophagus

• Diagnosing/distinguishing motility disorder (achalasia or oesophageal spasm)
• Indicated if barium swallow/endoscopy are unremarkable