Dysphagia DDx

Question 1

Associated with weight loss/anorexia

PMH: GORD, smoking, alcohol

Answer 1

Oesophageal cancer

Question 2

HPC: odynophagia, systemically well

PMH: heartburn

Answer 2

Oesophagitis

Question 3

PMH: HIV, steroid inhaler use

Answer 3

Oesophageal candidiasis

Question 4

Older man with dysphagia, halitosis, aspiration, chronic cough

If large: midline lump which gurgles on palpation

Answer 4

Pharyngeal pouch

Question 5

Dysphagia to both liquids and solids from the beginning, heartburn, regurgitation of food

Answer 5

Achalasia

Question 6

Associated with calcinosis, Raynaud’s, sclerodactyly, telangiectasia

Answer 6

Systemic sclerosis

Question 7

Extraocular muscle weakness or ptosis

Dysphagia to solids and liquids

Answer 7

Myasthenia gravis

Question 8

Intermittent painless dysphagia, PMH of anxiety

Answer 8

Globus hystericus

Question 9

Pathophysiology of achalasia?

Answer 9

Failure of relaxation of the LOS; dilatation of oesophagus and failure of peristalsis

Question 10

Investigations in suspected achalasia? (2)

Answer 10

Manometry- excessive LOS tone which doesn’t relax on swallowing
Barium swallow- grossly expanded oesophagus with “birds beak” appearance

Question 11

Management options for achalasia? (3)

Answer 11

Botulinum toxin injection
Balloon dilatation
Heller cardiomyotomy

Question 12

Management of benign peptic stricture?

Answer 12

Oesophageal balloon dilatation

Question 13

What is the advantage of cardiomyotomy over balloon dilatation for achalasia?

Answer 13

Myotomy does not require repeat procedures