Dysphagia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]

Synonyms and keywords: Approach to dysphagia, Dysphagia algorithm, Dysphagia workup, Dysphagia management, Dysphagia diagnostic approach

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Dysphagia is defined as “difficulty swallowing.” It is a sensation that suggests difficulty in the passage of solids or liquids from the mouth to the stomach. According to the International Classification of Diseases (ICD-10) which is endorsed by the WHO, dysphagia is a symptom rather than a disease. Dysphagia can result from propulsive failure, motility disorders, structural disorders, intrinsic or extrinsic compression of the oropharynx or esophagus. Dysphagia is distinguished from similar symptoms including odynophagia, which is defined as painful swallowing, and globus, which is the sensation of a lump in the throat. The endoscopy for esophageal dysphagia should be performed when the patient presented with symptoms of difficulty swallowing, painful swallowing, and aspiration. This is the standard test performed when the patient has a risk of developing pneumonia and diagnosing swallowing difficulties. Videofluoroscopic swallowing study is performed for oropharyngeal dysphagia. It provides information about delay in initiation of pharyngeal swallowing, nasopharyngeal regurgitation, residue of ingested food within the pharyngeal cavity after swallowing, and aspiration of ingested food. The cornerstone of any dysphagia evaluation is a detailed history and a thorough review of symptoms that can differentiate esophageal from oropharyngeal dysphagia and help predict the specific etiology of dysphagia with an accuracy of approximately 80% confirmed by specific testing. How a patient describes his or her difficulty and its timing, associated symptoms, and other characterizations may specifically denote the anatomic level of swallowing dysfunction.

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. There are no known life-threatening causes of dysphagia.

Depending upon the type of dysphagia, the causes can be categorized into two subsections:^{[1][2][3][4][5][6]}

The common causes of esophageal dysphagia can be divided into four categories.^{[7][8][9][10][11]}

Less common causes of dysphagia include:

• Scleredema adultorum^[12][13]
• Post chemotherapy and radiation therapy^[14]
• Descending thoracic aorta aneurysm^[15]
• Hypertrophy of cricopharyngeal muscles^[16]

To review a complete list of dysphagia causes, click here

Shown below is an algorithm summarizing the diagnosis of Oropharyngeal dysphagia according to the the World Gastroenterology Organisation Global Guidelines, International consensus (ICON) on assessment of oropharyngeal dysphagia and AGA technical review on management of oropharyngeal dysphagia.^[1][4][2]

Shown below is an algorithm summarizing the diagnosis of Esophageal dysphagia according the the World Gastroenterology Organisation Global Guidelines, and Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia.^[1][6]

Shown below is an algorithm summarizing the treatment of Oropharyngeal dysphagia according to the the World Gastroenterology Organisation Global Guidelines, International consensus (ICON) on assessment of oropharyngeal dysphagia and AGA technical review on management of oropharyngeal dysphagia.^[1][4][2]

Shown below is an algorithm summarizing the management of Esophageal dysphagia according the the World Gastroenterology Organisation Global Guidelines, and Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia.^[1][6]

• Evaluate for drugs causing decreased salivary flow or those causing esophageal mucosal injury.
• Treat underlying disorders first.

• Don’t perform endoscopy in patients with a history of prior radiation or caustic injury, history of surgery for laryngeal or esophageal cancer, complex stricture or risk of perforation.