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Latest revision as of 21:30, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]Kiran Singh, M.D. [3]

Overview

Dysphagia can be caused by many diseases such as neurological disorders, structural disorders of esophagus, tumors and motor disorders.

Causes

Depending upon the type of dysphagia, causes can be categorized into two subsections.^[1]^[2]^[3]^[4]

Common Causes of Oropharyngeal Dysphagia

Common causes of oropharyngeal dysphagia
Neurological	Medication side effects	Others
Stroke Parkinson's disease Occulopharyngeal dystrophy Amyotrophic lateral sclerosis Myasthenia gravis	Sedatives Hypnotic agents Anticonvulsants Neuroleptics Antihistamines Barbiturates Antiepileptics Corticosteroids Tetracycline L-tryptophan Anticholinergics.	Radiotherapy of the head and neck Pharyngitis Cervical web or rings Dental disease Oral candidiasis Tetanus Lead poisoning Rabies

Common causes of Esophageal Dysphagia

The common causes of esophageal dysphagia can be divided into four categories.^[5]^[6]^[7]^[8]^[9]

Structural (Mechanical) disorders				Motor disorders		Esophageal tumors	Systemic diseases	Miscellaneous
Intrinsic compression		Extrinsic Compression		Primary	Secondary	Esophageal tumors	Systemic diseases	Miscellaneous
Mucosal rings and webs Schatzki Plummer-Vinson Multiringed esophagus (eosinophilic esophagitis)	Strictures: PUD Caustic Pill-induced Radiation-induced	Vascular compression: Dysphagia lusoria (aberrant right subclavian artery) Dysphagia aortica (right-sided aorta) Cardio-megaly (enlarged left atrium)	Mediastinal masses: Lung cancer Lymphoma Lymphadenopathy Thyromegaly	Achalasia Diffuse esophageal spasm Hypertensive lower esophageal sphincter Ineffective esophageal motility disorder Nutcracker esophagus	Connective tissue diseases Scleroderma CREST syndrome Diabetes Chagas disease Paraneoplastic syndrome	Adenocarcinoma Squamous cell carcinoma Metastatic (breast or melanoma) Leiomyoma, lymphoma, or granular cell tumor	Scleroderma (multifactorial) Pemphigus/pemphigoid Lichen planus Crohn’s disease	Postsurgery (laryngeal, esophageal, or gastric cancers) Acute esophageal infections Esophageal diverticulae Foreign bodies

Less Common Causes

Less common causes of dysphagia include:

Scleredema adultorum^[10]^[11]
Post chemotherapy and radiation therapy^[12]
Descending thoracic aorta aneurysm^[13]
Hypertrophy of cricopharyngeal muscles^[14]

Causes by Organ System

The causes of dysphagia based on the organ system are as follows:^[15]^[16]

Cardiovascular	Aberrant subclavian artery, amyloidosis, anomalous left pulmonary artery,aortic aneurysm, aortic arch anomalies, charge syndrome, double aortic arch, enlarged aorta, enlarged left atrium, hypokalemia, mitral valve stenosis, pericarditis, superior vena cava syndrome
Chemical / poisoning	Arizona bark scorpion poisoning, arsenic poisoning, botulism, cobra poisoning, fluoride poisoning, lead poisoning
Dermatologic	Behcet's syndrome, dermatomyositis, polymyositis, Stevens-Johnson syndrome, systemic lupus erythematosus
Drug Side Effect	Antipsychotic medications, artemether and lumefantrin, atropine, botulinum toxin, bicalutamide chemotherapy, cyclosporine toxicity, cytarabine, dactinomycin, doxycycline, eletriptan, hydroxocobalamin hyoscyamine, ibandronate, ioxilan, ixabepilone, minocycline hydrochloride, nabumetone, neuroleptics, oxcarbazepine, pergolide, rimabotulinumtoxinb, riociguat, ropinirole, sargramostim, sertraline, scarlet fever, tiagabine
Ear Nose Throat	Carcinoma of the vocal tract, cricopharyngeal spasm, eagle syndrome, epiglottitis, Impaired sensitivity in the larynx, laryngeal cancer, nasopharyngeal carcinoma, oral pharyngeal disorders, oral submucous fibrosis, palatine tonsil, pharyngeal pouch, pharyngitis, pharynx cancer, quinsy, retropharyngeal abscess, tonsillar cancer
Endocrine	Cushing's syndrome, diabetic neuropathy, goiter, hyperthyroidism, hypokalemia, hypothyroidism, paraganglioma, Riedel thyroiditis, subacute granulomatous thyroiditis, thymoma, thyroglossal cyst, thyroid cancer, anaplastic,thyrotoxicosis, vagal paraganglioma, De Quervain's thyroiditis, solitary thyroid nodule
Environmental	No underlying causes
Gastroenterologic	Achalasia, adjustable gastric band, aerophagia, aspiration of foreign body, Barret's syndrome,candida esophagitis, cascade stomach, caustic esophagitis, Crohn's disease of the esophagus, diffuse esophageal spasm, diverticulum, eosinophilic esophagitis, eosinophilic gastroenteritis, esophageal atresia, esophageal cancer, esophageal cyst, esophageal diverticulum, esophageal leiomyoma, esophageal obstruction by a foreign body, esophageal pouch, esophageal spasm, esophageal stricture, esophageal web, esophageal moniliasis, esophageal sarcoidosis, esophageal trauma, esophagitis, esophagotracheal fistula, external esophageal compression, gastric cancer, gastric volvulus, gastritis, gastroesophageal reflux, gastrointestinal stromal tumor, gastroparesis, Gaucher disease, globus pharyngis, globus syndrome, hiatal hernia, hypertensive lower esophageal sphincter, infectious esophagitis, intramural pseudodiverticulosis, lymphocytic esophagitis, mitochondrial neurogastrointestinal encephalopathy syndrome, mucositis, myoneurogastrointestinal encephalopathy syndrome, nutcracker esophagus, odynophagia, peptic esophagitis, post surgery, peptic stricture, pharyngeal pouch, pill esophagitis, Plummer-Vinson syndrome, presbyphagia, pseudoachalasia, pyloric stenosis, radiation esophagitis, Schatzki ring, stomach cancer, upper oesophageal sphincter dysfunction, Wilson disease, zenker's diverticulum
Genetic	Aberrant subclavian artery, achalasia-addisonian syndrome, achromatopsia, adrenoleukodystrophy, ataxia neuropathy spectrum,Behcet's syndrome, chromosome 1p36 deletion syndrome, chromosome 22 ring, chromosome 22 trisomy mosaic, connective tissue disease, crisponi syndrome, Emanuel syndrome , extreme spinal curvature, Gaucher disease,Huntington disease, lissencephaly, type 1, x-linked , muscular dystrophy, Duchenne and Becker type ,myotonic dystrophy, nemaline myopathy1, oculopharyngeal muscular dystrophy, Opitz-frias syndrome, pseudoadrenoleukodystrophy, spinal muscular atrophy type I, spinocerebellar ataxia 17 , spinocerebellar ataxia 22, spinocerebellar ataxia, autosomal recessive 1, Stuve-wiedemann dysplasia, vascular ring with right aortic arch, Wiedemann–Rautenstrauch syndrome, Wilson disease
Hematologic	Agranulocytosis, mononucleosis, Plummer-Vinson syndrome
Iatrogenic	No underlying causes
Infectious Disease	Abscess, angina tonsillaris, botulism, candida esophagitis, Chagas disease, cytomegalovirus, diphtheria, epiglottitis, gastritis, herpangina, herpes simplex virus, infectious esophagitis,laryngeal papillomatosis, lassa fever, Ludwig's angina, lyme disease, lymph granulomatosis, Lymphadenopathy,Medication-induced esophagitis, mumps, neonatal tetanus , oral candidiasis, paracoccidioidomycosis, Pharyngitis, polio, poliomyelitis, postpolio syndrome, quinsy, rabies, retropharyngeal abscess, snakebites, stomatitis, syphilis, tetanus, tetrodotoxin, tonsillar abscess, ulcer, Vincent's angina
Musculoskeletal / Ortho	cytoplasmic body myopathy, Diffuse idiopathic skeletal hyperostosis, distal myopathy 2, elongated styloid process, extreme spinal curvature, inclusion body myositis, muscular dystrophy, Duchenne and Becker type, osteophytes, Pierre Robin's sequence
Neurologic	10th cranial nerve disorder, amyotrophic lateral sclerosis, Arnold–Chiari malformation, ataxia neuropathy spectrum, autonomic nerve disorders, autonomic neuropathy, autosomal recessive spastic paraplegia, type 11, Avellis syndrome, Babinski–Nageotte syndrome, basal ganglia disease, basilar artery insufficiency syndrome, brain stem gliomas, brainstem stroke, brainstem tumors, pseudobulbar palsy, bulbar palsy, Canomad syndrome, carotid paraganglioma, central pontine myelinosis, central vagal nucleus lesion, central hypoglossal nerve paralysis, cerebellar Infarction, cerebellar stroke, cerebral palsy, cerebrovascular accident, congenital myasthenic syndrome, cervical osteophytes, dementia, diabetic neuropathy, dystonia, epileptic encephalopathy, early infantile, 1, fosmn syndrome, Guillain-Barre Syndrome, head trauma, Huntington disease, infantile striato-thalamic degeneration, lateral funiculus angina, lateral medullary syndrome, Lhermitte-cornil-quesnel syndrome, lissencephaly, type 1, x-linked, metabolic encephalopathies, microcephaly, mitochondrial neurogastrointestinal encephalopathy syndrome, motor neuron disease, multiple sclerosis, multiple system atrophy, muscular dystrophy, Duchenne and Becker type, myasthenia gravis, myoneurogastrointestinal encephalopathy syndrome, myopathy, myotonic dystrophy, neuroferritinopathy, neurosarcoidosis, osmotic demyelination syndrome, Pallidopyramidal syndrome, paraganglioma, paraneoplastic limbic encephalitis, Parkinson disease, peripheral neuropathy, peripheral tongue paralysis, polyradiculitis, pontocerebellar hypoplasia type 2a, primary lateral sclerosis, adult, primary motility disorders, Pseudobulbar paralysis,pseudodysphagia, secondary motility disorders, Shy-Drager syndrome, spastic paraplegia 11, autosomal recessive, spinal muscular atrophy type I, spinocerebellar ataxia 17 , spinocerebellar ataxia 22 , spinocerebellar ataxia, autosomal recessive 1, striatonigral degeneration infantile, stroke, syringobulbia, tardive dyskinesia, vagus nerve palsy, Wallenberg's syndrome
Nutritional / Metabolic	Adrenoleukodystrophy, amyloidosis, Gaucher disease, hydroxocobalamin, hypokalemia, Plummer-Vinson syndrome, Wilson disease
Obstetric/Gynecologic	Leiomyoma
Oncologic	Acoustic neuroma, brain stem gliomas, brain stem tumors, bronchial carcinoma, carcinoma of the vocal tract, carotid body tumor, chordoma, esophageal cancer, gastric cancer, laryngeal cancer, laryngeal carcinoma, leiomyoma, lymphadenopathy, malignant lung cancer, malignant mesothelioma, nasopharyngeal carcinoma, neck cancer, odontoma, Oral cavity tumor, oropharyngeal cancer, palate cancer, paraganglioma, paraneoplastic limbic encephalitis, paraneoplastic syndrome, pharynx cancer, small cell lung cancer, stomach cancer, supraglottic laryngeal cancer, throat cancer, thyroid cancer, anaplastic, tongue cancer, tonsillar cancer, vagal paraganglioma
Opthalmologic	Achromatopsia, oculopharyngeal muscular dystrophy
Overdose / Toxicity	Alcoholism
Psychiatric	Anxiety disorders, dementia, frontotemporal dementia, functional disorders, global hystericus, rumination disorder, tardive dyskinesia
Pulmonary	Bronchial carcinoma, congenital bronchogenic cyst, epiglottitis, malignant lung cancer, malignant mesothelioma mediastinal mass, mediastinitis, Ondine's curse, pharyngitis, pleuritis, sarcoidosis
Renal / Electrolyte	Hypomagnesemia primary, hypophosphatemia, systemic lupus erythematosus
Rheum / Immune / Allergy	Allergic swelling, amyloidosis, Behcet's syndrome, Canomad syndrome, cervical osteophytes, CREST syndrome, dermatomyositis, diffuse systemic sclerosi, fibrosis, graft-versus-host disease, inclusion body myositis, muscular dystrophy, oculopharyngeal muscular dystrophy, osteophytes, paraneoplastic syndrome, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, sarcoidosis, scleroderma, stomatitis, systemic lupus erythematosus, systemic sclerosis, trismus
Sexual	No underlying causes
Trauma	Head trauma
Urologic	No underlying causes
Dental	Vincent's angina
Miscellaneous	Franek-bocker-kahlen syndrome, palatoplegia, tongue conditions, vascular abnormality

References

↑ Starmer HM, Riley LH, Hillel AT, Akst LM, Best SR, Gourin CG (2014). "Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery". Dysphagia. 29 (1): 68–77. doi:10.1007/s00455-013-9482-9. PMID 23943072.
↑ Inayat F, Hussain Q, Shafique K (2017). "Dysphagia Caused by Extrinsic Esophageal Compression From Mediastinal Lymphadenopathy in Patients With Sarcoidosis". Clin Gastroenterol Hepatol. 15 (7): e119–e120. doi:10.1016/j.cgh.2016.11.010. PMID 27840183.
↑ Oda K, Iwakiri R, Hara M, Watanabe K, Danjo A, Shimoda R; et al. (2005). "Dysphagia associated with gastroesophageal reflux disease is improved by proton pump inhibitor". Dig Dis Sci. 50 (10): 1921–6. doi:10.1007/s10620-005-2962-5. PMID 16187198.
↑ Roman S, Kahrilas PJ (2014). "The diagnosis and management of hiatus hernia". BMJ. 349: g6154. doi:10.1136/bmj.g6154. PMID 25341679.
↑ Xiao Y, Kahrilas PJ, Nicodème F, Lin Z, Roman S, Pandolfino JE (2014). "Lack of correlation between HRM metrics and symptoms during the manometric protocol". Am J Gastroenterol. 109 (4): 521–6. doi:10.1038/ajg.2014.13. PMC 4120962. PMID 24513804.
↑ Enestvedt BK, Williams JL, Sonnenberg A (2011). "Epidemiology and practice patterns of achalasia in a large multi-centre database". Aliment Pharmacol Ther. 33 (11): 1209–14. doi:10.1111/j.1365-2036.2011.04655.x. PMC 3857989. PMID 21480936.
↑ Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992). "Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh". Gut. 33 (8): 1011–5. PMC 1379432. PMID 1398223.
↑ Pandolfino JE, Gawron AJ (2015). "Achalasia: a systematic review". JAMA. 313 (18): 1841–52. doi:10.1001/jama.2015.2996. PMID 25965233.
↑ Gockel I, Lord RV, Bremner CG, Crookes PF, Hamrah P, DeMeester TR (2003). "The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction". J Gastrointest Surg. 7 (5): 692–700. PMID 12850684.
↑ Chatterjee S, Hedman BJ, Kirby DF (2017). "An Unusual Cause of Dysphagia". J Clin Rheumatol. doi:10.1097/RHU.0000000000000666. PMID 29280826.
↑ Wright RA, Bernie H (1982). "Scleredema adultorum of Buschke with upper esophageal involvement". Am J Gastroenterol. 77 (1): 9–11. PMID 7064968.
↑ Nguyen NP, Sallah S, Karlsson U, Antoine JE (2002). "Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues". Cancer. 94 (4): 1131–41. PMID 11920484.
↑ Conte, Blagio A. (1966). "Dysphagia Caused by an Aneurysm of the Descending Thoracic Aorta". New England Journal of Medicine. 274 (17): 956–957. doi:10.1056/NEJM196604282741710. ISSN 0028-4793.
↑ Benedict, Edward B.; Sweet, Richard H. (1955). "Dysphagia Due to Hypertrophy of the Cricopharyngeus Muscle or Hypopharyngeal Bar". New England Journal of Medicine. 253 (26): 1161–1162. doi:10.1056/NEJM195512292532607. ISSN 0028-4793.
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Template:WH Template:WS

[pmid23943072-1] Starmer HM, Riley LH, Hillel AT, Akst LM, Best SR, Gourin CG (2014). "Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery". Dysphagia. 29 (1): 68–77. doi:10.1007/s00455-013-9482-9. PMID 23943072.

[pmid27840183-2] Inayat F, Hussain Q, Shafique K (2017). "Dysphagia Caused by Extrinsic Esophageal Compression From Mediastinal Lymphadenopathy in Patients With Sarcoidosis". Clin Gastroenterol Hepatol. 15 (7): e119–e120. doi:10.1016/j.cgh.2016.11.010. PMID 27840183.

[pmid16187198-3] Oda K, Iwakiri R, Hara M, Watanabe K, Danjo A, Shimoda R; et al. (2005). "Dysphagia associated with gastroesophageal reflux disease is improved by proton pump inhibitor". Dig Dis Sci. 50 (10): 1921–6. doi:10.1007/s10620-005-2962-5. PMID 16187198.

[pmid25341679-4] Roman S, Kahrilas PJ (2014). "The diagnosis and management of hiatus hernia". BMJ. 349: g6154. doi:10.1136/bmj.g6154. PMID 25341679.

[pmid24513804-5] Xiao Y, Kahrilas PJ, Nicodème F, Lin Z, Roman S, Pandolfino JE (2014). "Lack of correlation between HRM metrics and symptoms during the manometric protocol". Am J Gastroenterol. 109 (4): 521–6. doi:10.1038/ajg.2014.13. PMC 4120962. PMID 24513804.

[pmid21480936-6] Enestvedt BK, Williams JL, Sonnenberg A (2011). "Epidemiology and practice patterns of achalasia in a large multi-centre database". Aliment Pharmacol Ther. 33 (11): 1209–14. doi:10.1111/j.1365-2036.2011.04655.x. PMC 3857989. PMID 21480936.

[pmid1398223-7] Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992). "Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh". Gut. 33 (8): 1011–5. PMC 1379432. PMID 1398223.

[pmid25965233-8] Pandolfino JE, Gawron AJ (2015). "Achalasia: a systematic review". JAMA. 313 (18): 1841–52. doi:10.1001/jama.2015.2996. PMID 25965233.

[pmid12850684-9] Gockel I, Lord RV, Bremner CG, Crookes PF, Hamrah P, DeMeester TR (2003). "The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction". J Gastrointest Surg. 7 (5): 692–700. PMID 12850684.

[pmid29280826-10] Chatterjee S, Hedman BJ, Kirby DF (2017). "An Unusual Cause of Dysphagia". J Clin Rheumatol. doi:10.1097/RHU.0000000000000666. PMID 29280826.

[pmid7064968-11] Wright RA, Bernie H (1982). "Scleredema adultorum of Buschke with upper esophageal involvement". Am J Gastroenterol. 77 (1): 9–11. PMID 7064968.

[pmid11920484-12] Nguyen NP, Sallah S, Karlsson U, Antoine JE (2002). "Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues". Cancer. 94 (4): 1131–41. PMID 11920484.

[Conte1966-13] Conte, Blagio A. (1966). "Dysphagia Caused by an Aneurysm of the Descending Thoracic Aorta". New England Journal of Medicine. 274 (17): 956–957. doi:10.1056/NEJM196604282741710. ISSN 0028-4793.

[BenedictSweet1955-14] Benedict, Edward B.; Sweet, Richard H. (1955). "Dysphagia Due to Hypertrophy of the Cricopharyngeus Muscle or Hypopharyngeal Bar". New England Journal of Medicine. 253 (26): 1161–1162. doi:10.1056/NEJM195512292532607. ISSN 0028-4793.

[15] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[16] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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@@ Line 5: / Line 5: @@
 ==Overview==
-Dysphagia has a couple of categories of causes which can be classified on the basis of location and the organ system involved.
+Dysphagia can be caused by many diseases such as neurological disorders, structural disorders of esophagus, tumors and motor disorders.
 ==Causes==
-Dysphagia has a couple of categories of causes which can be classified on the basis of location and the organ system involved.
+Depending upon the type of dysphagia, causes can be categorized into two subsections.<ref name="pmid23943072">{{cite journal| author=Starmer HM, Riley LH, Hillel AT, Akst LM, Best SR, Gourin CG| title=Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. | journal=Dysphagia | year= 2014 | volume= 29 | issue= 1 | pages= 68-77 | pmid=23943072 | doi=10.1007/s00455-013-9482-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23943072  }} </ref><ref name="pmid27840183">{{cite journal| author=Inayat F, Hussain Q, Shafique K| title=Dysphagia Caused by Extrinsic Esophageal Compression From Mediastinal Lymphadenopathy in Patients With Sarcoidosis. | journal=Clin Gastroenterol Hepatol | year= 2017 | volume= 15 | issue= 7 | pages= e119-e120 | pmid=27840183 | doi=10.1016/j.cgh.2016.11.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840183  }} </ref><ref name="pmid16187198">{{cite journal| author=Oda K, Iwakiri R, Hara M, Watanabe K, Danjo A, Shimoda R et al.| title=Dysphagia associated with gastroesophageal reflux disease is improved by proton pump inhibitor. | journal=Dig Dis Sci | year= 2005 | volume= 50 | issue= 10 | pages= 1921-6 | pmid=16187198 | doi=10.1007/s10620-005-2962-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16187198  }} </ref><ref name="pmid25341679">{{cite journal| author=Roman S, Kahrilas PJ| title=The diagnosis and management of hiatus hernia. | journal=BMJ | year= 2014 | volume= 349 | issue=  | pages= g6154 | pmid=25341679 | doi=10.1136/bmj.g6154 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25341679  }} </ref>
 ===Common Causes of Oropharyngeal Dysphagia===
@@ Line 14: / Line 14: @@
 ! colspan="3" |Common causes of oropharyngeal dysphagia
 |-
-|[[stroke|Neurological causes]]
+!Neurological
-|Medications
+!Medication side effects
-|Other
+!Others
-causes
 |-
 |
-* Stroke
+* [[Stroke]]
-* Parkinson's disease
+* [[Parkinson's disease]]
 * Occulopharyngeal dystrophy
-* Amyotrophic lateral sclerosis
+* [[Amyotrophic lateral sclerosis]]
-* Myasthenia gravis
+* [[Myasthenia gravis]]
 |
-* S[[sedatives|edatives]]
+* [[Sedatives]]
-* Hypnotic agents
+* [[Hypnotics|Hypnotic agents]]
-* [[anticonvulsants]]
+* [[Anticonvulsants]]
-* [[neuroleptics]]
+* [[Neuroleptics]]
-* [[antihistamines]]
+* [[Antihistamines]]
-* [[barbiturates]]
+* [[Barbiturates]]
-* Antiseizure medication
+* [[Antiepileptics]]
-* Medications can also cause [[peripheral nervous system]] effects resulting in an oropharyngeal dysphagia. Examples: [[corticosteroids]], [[tetracycline]], [[L-tryptophan]], and [[anticholinergic]]s<ref name="Murray" />
+* [[Corticosteroids]]
+* [[Tetracycline]]
+* [[L-tryptophan]]
+* [[Anticholinergics|Anticholinergics.]]
 |
-* Radiotherapy of the head and neck
+* [[Radiation therapy|Radiotherapy]] of the head and neck
-* Pharyngitis
+* [[Pharyngitis]]
 * Cervical web or rings
-* Dental problems
+* Dental disease
-* Oral candidiasis
+* [[Oral candidiasis]]
-* Tetanus
+* [[Tetanus]]
-* Lead poisoning
+* [[Lead poisoning]]
-* Rabies
+* [[Rabies]]
 |}
 ===Common causes of Esophageal Dysphagia===
+The common causes of esophageal dysphagia can be divided into four categories.<ref name="pmid24513804">{{cite journal| author=Xiao Y, Kahrilas PJ, Nicodème F, Lin Z, Roman S, Pandolfino JE| title=Lack of correlation between HRM metrics and symptoms during the manometric protocol. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 4 | pages= 521-6 | pmid=24513804 | doi=10.1038/ajg.2014.13 | pmc=4120962 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24513804  }} </ref><ref name="pmid21480936">{{cite journal| author=Enestvedt BK, Williams JL, Sonnenberg A| title=Epidemiology and practice patterns of achalasia in a large multi-centre database. | journal=Aliment Pharmacol Ther | year= 2011 | volume= 33 | issue= 11 | pages= 1209-14 | pmid=21480936 | doi=10.1111/j.1365-2036.2011.04655.x | pmc=3857989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21480936  }} </ref><ref name="pmid1398223">{{cite journal| author=Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC| title=Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. | journal=Gut | year= 1992 | volume= 33 | issue= 8 | pages= 1011-5 | pmid=1398223 | doi= | pmc=1379432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1398223  }} </ref><ref name="pmid25965233">{{cite journal| author=Pandolfino JE, Gawron AJ| title=Achalasia: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 18 | pages= 1841-52 | pmid=25965233 | doi=10.1001/jama.2015.2996 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25965233  }} </ref><ref name="pmid12850684">{{cite journal| author=Gockel I, Lord RV, Bremner CG, Crookes PF, Hamrah P, DeMeester TR| title=The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction. | journal=J Gastrointest Surg | year= 2003 | volume= 7 | issue= 5 | pages= 692-700 | pmid=12850684 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12850684  }} </ref>
 {| class="wikitable"
-!Structural (Mechanical) Disorders
+! colspan="4" |Structural (Mechanical) disorders
-!Esophageal tumors
+! colspan="2" |Motor disorders
-!Systemic diseases
+! rowspan="2" |Esophageal tumors
-!Miscellaneous
+! rowspan="2" |Systemic diseases
-! colspan="2" |Motor Disorders
+! rowspan="2" |Miscellaneous
 |-
-|'''Intrinsic compression:'''
+! colspan="2" |'''Intrinsic compression'''
-* Mucosal rings and webs:
+! colspan="2" |'''Extrinsic Compression'''
-** Schatzki
+!'''Primary'''
-** Plummer-Vinson
+!'''Secondary'''
-** Multiringed esophagus (eosinophilic esophagitis)
+|-
+|'''Mucosal rings and webs'''
-* Strictures (inflammatory or fibrotic):
+* [[Schatzki ring|Schatzki]]
-** Peptic
+* [[Plummer-Vinson syndrome|Plummer-Vinson]]
-** Caustic
+* Multiringed esophagus [[Eosinophilic esophagitis|(eosinophilic esophagitis]])
-** Pill-induced
+|'''Strictures:'''
-** Radiation-induced
+* [[Peptic ulcer|PUD]]
-'''Extrinsic Compression:'''
+* [[Caustic]]
-* Mediastinal masses:
+* Pill-induced
-** Lung cancer
+* Radiation-induced
-** Lymphoma
+|'''Vascular compression:'''
-** Lymph node
+* Dysphagia lusoria (aberrant right subclavian artery)
-** Thyromegaly
+* Dysphagia aortica (right-sided aorta)
-* Vascular compression:
+* [[Cardiomegaly|Cardio-megaly]] (enlarged left atrium)
-** Dysphagia lusoria (aberrant right subclavian artery)
+|
-** Dysphagia aortica (right-sided aorta)
+* '''Mediastinal masses:'''
-** Cardio-megaly (enlarged left atrium)
+** [[Lung cancer]]
+** [[Lymphoma]]
+** [[Lymphadenopathy]]
+** [[Thyromegaly]]
+|
+* [[Achalasia]]
+* [[Diffuse esophageal spasm]]
+* Hypertensive lower esophageal sphincter
+* Ineffective esophageal motility disorder
+* [[Nutcracker esophagus]]
+|
+* Connective tissue diseases
+* [[Scleroderma]]
+* [[CREST syndrome]]
+* [[Diabetes mellitus|Diabetes]]
+* [[Chagas disease]]
+* [[Paraneoplastic syndrome]]
 |
-* Adenocarcinoma
+* [[Adenocarcinoma]]
-* Squamous cell carcinoma
+* [[Squamous cell carcinoma]]
 * Metastatic (breast or melanoma)
-* Leiomyoma, lymphoma, or granular cell tumor
+* [[Leiomyoma]], [[lymphoma]], or [[granular cell tumor]]
 |
-* Scleroderma (multifactorial)
+* [[Scleroderma]] (multifactorial)
 * Pemphigus/pemphigoid
-* Lichen planus
+* [[Lichen planus]]
-* Crohn’s disease
+* [[Crohn's disease|Crohn’s disease]]
 |
-* Postsurgery (laryngeal, esophageal, or gastric cancers)
+* Postsurgery ([[Laryngeal cancer|laryngeal]], [[Esophageal cancer|esophageal]], or [[Stomach cancer|gastric cancers]])
-* Acute esophageal infections
+* Acute [[Esophagitis|esophageal infections]]
 * Esophageal diverticulae
 * Foreign bodies
-|'''Primary''':
-* Achalasia
-* Diffuse esophageal spasm
-* Hypertensive lower esophageal sphincter
-* Ineffective esophageal motility disorder
-* Nutcracker esophagus
-|'''Secondary:'''
-* Connective tissue diseases
-* Scleroderma
-* CREST syndrome, diabetes
-* Chagas disease
-* Paraneoplastic syndrome
 |}
-===Rare causes===
+===Less Common Causes===
-{| class="wikitable"
+Less common causes of dysphagia include:
-!Rare causes
-|-
-|
 * Scleredema adultorum<ref name="pmid29280826">{{cite journal| author=Chatterjee S, Hedman BJ, Kirby DF| title=An Unusual Cause of Dysphagia. | journal=J Clin Rheumatol | year= 2017 | volume=  | issue=  | pages=  | pmid=29280826 | doi=10.1097/RHU.0000000000000666 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29280826  }} </ref><ref name="pmid7064968">{{cite journal| author=Wright RA, Bernie H| title=Scleredema adultorum of Buschke with upper esophageal involvement. | journal=Am J Gastroenterol | year= 1982 | volume= 77 | issue= 1 | pages= 9-11 | pmid=7064968 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7064968  }} </ref>
 * Post chemotherapy and radiation therapy<ref name="pmid11920484">{{cite journal| author=Nguyen NP, Sallah S, Karlsson U, Antoine JE| title=Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. | journal=Cancer | year= 2002 | volume= 94 | issue= 4 | pages= 1131-41 | pmid=11920484 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11920484  }} </ref>
 * Descending thoracic aorta aneurysm<ref name="Conte1966">{{cite journal|last1=Conte|first1=Blagio A.|title=Dysphagia Caused by an Aneurysm of the Descending Thoracic Aorta|journal=New England Journal of Medicine|volume=274|issue=17|year=1966|pages=956–957|issn=0028-4793|doi=10.1056/NEJM196604282741710}}</ref>
 * Hypertrophy of cricopharyngeal muscles<ref name="BenedictSweet1955">{{cite journal|last1=Benedict|first1=Edward B.|last2=Sweet|first2=Richard H.|title=Dysphagia Due to Hypertrophy of the Cricopharyngeus Muscle or Hypopharyngeal Bar|journal=New England Journal of Medicine|volume=253|issue=26|year=1955|pages=1161–1162|issn=0028-4793|doi=10.1056/NEJM195512292532607}}</ref>
-*
-|}
 ===Causes by Organ System===
@@ Line 231: / Line 233: @@
 |-
 |}
-===Common Causes of Esophageal Dysphagia===
-* '''''Peptic stricture''''', or narrowing of the esophagus, is usually a complication of acid reflux, most commonly due to [[gastroesophageal reflux]] ([[GERD]]). These patients are usually older and have had [[GERD]] for a long time. Acid reflux can also be due to other causes, such as [[Zollinger-Ellison syndrome]], NG tube placement, and [[scleroderma]]. Other non-acid related causes of peptic strictures include infectious esophagitis, ingestion of chemical irritant, pill irritation, and radiation. Peptic stricture is a progressive mechanical dysphagia, meaning patients will complain of initial intolerance to solids followed by inability to tolerate liquids. Usually the threshold to solid intolerance is 13 mm of the esophageal lumen. Symptoms relating to the underlying cause of the stricture usually will also be present.
-* '''''[[Esophageal cancer]]''''' also presents with progressive mechanical dysphagia. Patients usually come with rapidly progressive dysphagia first with solids then with liquids, weight loss (> 10 kg), and anorexia (loss of appetite). Esophageal cancer usually affects the elderly. Esophageal cancers can be either squamous cell carcinoma or [[adenocarcinoma]]. [[Adenocarcinoma]] is the most prevalent in the US and is associated with patients with chronic GERD who has developed [[Barrett's esophagus]] (intestinal [[metaplasia]] of esophageal mucosa). Squamous cell carcinoma is more prevalent in Asia and is associated with tobacco smoking and alcohol use.
-{{main|esophageal cancer}}
-* '''''Esophageal rings and [[esophageal web|web]]s''''', are actual rings and webs of tissue that may occlude the esophageal lumen.
-** ''Rings'' --- Also known as [[Schatzki ring]]s from the discoverer, these rings are usually mucosal rings rather than muscular rings, and are located near the gastroesophageal junction at the squamo-columnar junction. Presence of multiple rings may suggest [[eosinophilic esophagitis]]. Rings cause intermittent mechanical dysphagia, meaning patients will usually present with transient discomfort and regurgitation while swallowing solids and then liquids, depending on the constriction of the ring.
-** ''Webs'' --- Usually squamous mucosal protrusion into the esophageal lumen, especially anterior cervical esophagus behind the [[cricoid]] area. Patients are usually asymptomatic or have intermittent dysphagia. An important association of esophageal webs is to the [[Plummer-Vinson syndrome]] in [[iron deficiency]], in which case patients will also have anemia, koilonychia, fatigue, and other symptoms of [[anemia]].
-{{main|esophageal web}}
-* '''''[[Achalasia]]''''' is an idiopathic motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation as well as loss of [[peristalsis]] in the distal esophagus, which is mostly smooth muscle. Both of these features impair the ability of the esophagus to empty contents into the stomach. Patients usually complain of dysphagia to both solids and liquids. Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn. The combination of achalasia, adrenal insufficiency, and alacrima (lack of tear production) in children is known as the triple A (Allgrove) syndrome. In most cases the cause is unknown (idiopathic), but in some regions of the world, achalasia can also be caused by [[Chagas disease]] due to infection by ''[[Trypanosoma cruzi]]''.
-{{main|achalasia}}
-* '''''[[Scleroderma]]''''' is a disease characterized by [[atrophy]] and [[sclerosis]] of the gut wall, most commonly of the distal esophagus (~90%). Consequently, the lower esophageal sphincter cannot close and this can lead to severe gastroesophageal reflux disease (GERD). Patients typically present with progressive dysphagia to both solids and liquids secondary to motility problems or peptic stricture from acid reflux.
-{{main|scleroderma}}
-* '''''Spastic motility disorders''''' include [[diffuse esophageal spasm]] (DES), [[nutcracker esophagus]], hypertensive lower esophageal sphincter, and nonspecific spastic esophageal motility disorders (NEMD).
-** ''DES'' can be caused by many factors that affect muscular or neural functions, including acid reflux, stress, hot or cold food, or carbonated drinks. Patients present with intermittent dysphagia, chest pain, or heartburn.
-* [[Diverticulum]]
-* [[Aberrant subclavian artery]], or ([[Ortner's syndrome|dysphagia lusoria]])
-* Cervical osteophytes
-* [[Enlarged aorta]]
-* [[Enlarged left atrium]]
-* [[Mediastinal tumor]]
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Crowdiagnosis]]
 [[Category:Geriatrics]]
 [[Category:Gastroenterology]]
 [[Category:Otolaryngology]]
-[[Category:Primary care]]
-{{WH}}
-{{WS}}