Presentations - Dysphagia

Question 1

What is dysphagia?

Answer 1

Difficulty swallowing

Question 2

How is dysphagia categorised?

Answer 2

Mechanical obstruction - e.g. cancer

Motility disorders - e.g. achalasia

Question 3

What should be assumed in patients without convincing history in dysphagia?

Answer 3

Upper GI tract malignancy until proven otherwise

Question 4

What is the first-line investigation for patients with dysphagia?

Answer 4

Urgent upper GI endoscopy

Question 5

What are the mechanical causes of dysphagia?

Answer 5

• Oesophageal cancer, gastric cancer or HNN cancer
• Benign oesophageal strictures
• Extrinsic compression (thyroid goitre)
• Pharyngeal pouch
• Foreign body (children)
• Oesophageal web

Question 6

What are the motility causes of dysphagia?

Answer 6

• Cerebrovascular
• Achalasia
• Diffuse oesophageal spasm
• Eosinophilic oesophagitis
• Neurological disorders- MS, ALS, MG
• Muscular disorders
• Rheum conditions - systemic sclerosis

Question 7

What should you ask in a patient with dysphagia?

Answer 7

Is there difficulty in initiating swallowing?

Do you cough after swallowing?

Do you have to swallow a few times to get the food to pass your throat?

Reflux, dyspepsia, hoarse voice, referred pain

Weight loss

Question 8

What is odynophagia?

Answer 8

Pain when swallowing

Question 9

Where should you examine in a patient with dysphagia?

Answer 9

Mouth - oral disease

Neck - lymphadenopathy

Abdomen - masses

Question 10

What investigations are done in a patient with dysphagia?

Answer 10

Routine bloods

Upper GI endoscopy (OGD)

If normal OGD investigate eosinophilic oesophagitis

Question 11

How are motility disorders investigated?

Answer 11

Manometry testing

Assesses motor function of the upper oesophageal sphincter, body and lower sphincter

Gives definitive diagnosis

Question 12

How is dysphagia managed?

Answer 12

Treat underlying cause

Involve dietitican for nutritional status as will likely be malnourished

SALT referral

MDT if cancer
Neurologist if neurological cause

Question 13

What is the blood supply to the inferior third of the oesophagus?

Answer 13

Left gastric artery