GI: Dysphagia

Question 1

What is dysphagia?

Answer 1

Difficulty in swallowing

Question 2

What is odynophagia?

Answer 2

Pain on swallowing

Question 3

What are the 5 key questions you want to ask about if someone is having problems with dysphagia?

Answer 3

• Difficulty with solids + liquids from start?
• Difficult to initiate the swallowing movement?
• Is it painful?
• Is it constant or intermittent?
• Does the neck bulge or gurgle when drinking?

Question 4

If someone develope dysphagia of both solids and liquids, what would you be thinking in terms of causes?

Answer 4

Motility disorders - achalasia, CNS/pharyngeal dysfunction

Question 5

If someone developed difficulty swallowing solids, followed by difficulty swallowing liquids, what might you suspect to be the cause?

Answer 5

Suspect stricture - Benign/malignant

Question 6

If someone with dysphagia found it difficult to initiate the movement of swallowing, what might you suspect the cause to be?

Answer 6

Bulber palsy - especially if it presents

Question 7

If swallowing is painful, what might you suspect as the cause?

Answer 7

• Ulceration - due to malignancy, oesophagitis, viral infection, fungal infection
• Spasm

Question 8

If someone was having intermittent dysphagia, what might be the cause?

Answer 8

Oesophageal spasm

Question 9

If someone had constant dysphagia, what might you suspect to be the cause?

Answer 9

Stricture, unlike intermittent which would indicate spasm

Question 10

What might gurgling or bulging on drinking combined with dysphagia suggest?

Answer 10

May have pharyngeal pouch

Question 11

What signs would you want to look for in someone with dysphagia?

Answer 11

• Cachexia
• Anaemia
• Lymphadenopathy
• Systemic disease e.g. systemic sclerosis, CNS disease

Question 12

What are disoders of motility that can cause dysphagia?

Answer 12

• Achalasia
• Diffuse oesophageal spasm
• Systemic sclerosis
• Bulbar/Pseudobulbar Palsy
• Parkinson’s disease
• Wilson’s Disease
• Myasthenia gravis

Question 13

What are non-motility related causes of dysphagia?

Answer 13

• Malignant/Benign stricture
• Extrinsic pressure - Lung cancer, mediastinal lymph nodes, Aortic aneurysm
• Pharyngeal pouch
• Oesophagitis
• Globus

Question 14

What investigations would you consider doing in someone presenting with dysphagia?

Answer 14

• Bloods - FBC, U+E’s
• Other - Upper GI endoscopy +/- biopsy, Swallow contrast, oesophageal manometry, video fluoroscopy

Question 15

How would you manage benign oesophagal stricture?

Answer 15

Balloon dilatation