DYSPHAGIA

Question 1

WHAT IS DYSPHAGIA?

Answer 1

difficulty swallowing

Question 2

WHAT IS ODONYPHAGIA?

Answer 2

painful swallowing

Question 3

WHAT IS OESOPHAGEAL DYSPHAGIA AND ITS CAUSES?

Answer 3

• food leaves mouth ok and then get stuck
• caused by obstruction such as tumour, oesophagitis inflammation/ neuromuscular problem such as achalasia, dysmotility, presbyoesophagus

Question 4

WHAT IS ORO-PHARYNGEAL DYSPAHGIA AND ITS CAUSES?

Answer 4

• patients struggle to get the food to leave the mouth due to problems coordinating the muscle that move the food bolus to back of the mouth
• caused by stroke

Question 5

WHAT ARE MECHANICAL CAUSES FOR DYSPAHGIA?

Answer 5

• foreign body
• malignancy - oesophageal or gastric
• pharyngeal pouch

Question 6

WHAT ARE NEUROMUSCULAR CAUSES FOR DYSPHAGIA?

Answer 6

• stroke
• achalasia
• myasthenia gravis
• motor neurone disease

Question 7

WHAT 5 KEY QUESTIONS NEED TO BE ASKED AND WHY?

Answer 7

1) Was there difficulty swallowing solids and liquids from the start? yes then motility disorder such as achalasia/ no solids then liquids then stricture (benign or malignant)
2) Is it difficult to initiate swallowing movement?
3) Is swallowing painful? yes then suspect ulceration (malignancy, infection)
4) Is dysphagia intermittent or constant and getting worse
5) Does the neck bulge or gurgle on drinking? yes then pharyngeal pouch

Question 8

WHAT MAIN INVESTIGATION SHOULD BE PERFORMED FOR DYSPHAGIA?

Answer 8

Upper GI endoscopy and biopsy

Question 9

WHAT INVESITGATION SHOULD BE PERFORMED IF ENDSOCOPY IS NORMAL BUT MOTILITY DISORDER SUSPECTED?

Answer 9

manometry - assess strength and muscle coordination when you swallow

Question 10

WHEN SHOULD AN URGENT UPPER GO ENDOSCOPY BE OFFERED FOR SUSPECTED OESOPHAGEAL CANCER?

Answer 10

• dysphagia
• aged ≥55yrs with weight loss plus upper abdominal pain
• reflux
• dyspepsia