Dysphagia classical exam features (Passmed)

Question 1

Oesophageal cancer

Answer 1

May be associated with weight loss, anorexia or vomiting during eating
PMH including Barrett’s oesophagus, GORD, excessive smoking, alcohol use

Question 2

Oesophagitis

Answer 2

Hx of heartburn

Odynophagia but no weight loss & systemically well

Question 3

Oesophageal candidiasis

Answer 3

Pain on swallowing
History of risk factors:
- HIV
- Steroid inhaler use

Question 4

Achalasia

Answer 4

Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc

Question 5

Pharyngeal pouch

Answer 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: dysphagia, regurgitation, aspiration, chronic cough
Halitosis occasionally seen

Question 6

Systemic sclerosis

Answer 6

Other features of CREST syndrome may be present:

• Calcinosis
• Raynaud’s phenomenon
• oEsophageal dysmotility
• Sclerodactyly
• Telangiectasia

As well as oesophageal dysmotility the lower oesophageal sphincter (LES) pressure is decreased. This contrasts to achalasia where the LES pressure is increased

Question 7

Myasthenia gravis

Answer 7

Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids

Question 8

Globus hystericus

Answer 8

May be Hx of anxiety
Symptoms often intermittent, relived by swallowing
Usually painless - presence of pain should warrant further investigation for organic causes