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{{Dysphagia}}
{{Dysphagia}}


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


==Causes==
==Causes==
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===
===Common Causes of Oropharyngeal Dysphagia===
* A [[stroke]] can trigger a rapid onset of dysphagia with a high occurrence of aspiration.  The function of normal [[swallowing]] may or may not return completely following an acute phase lasting approximately 6 weeks. <ref name="Murray">Murray, J.  (1999).  ''Manual of Dysphagia Assessment in Adults''.  San Diego: Singular Publishing. </ref>
{| class="wikitable"
*  [[Parkinson's disease]] can cause "multiple prepharyngeal, pharyngeal, and esophageal abnormalities".  The severity of the disease most often correlates with the severity of the swallowing disorder.<ref name="Murray"> </ref>
! colspan="3" |Common causes of oropharyngeal dysphagia
* Neurologic disorders such as [[stroke]], [[Parkinson's disease]], [[amyotrophic lateral sclerosis]], [[Bell's palsy]], or [[myasthenia gravis]] can cause weakness of facial and lip muscles that are involved in coordinated mastication as well as weakness of other important [[Mastication#Muscles of mastication|muscles of mastication]] and swallowing.
|-
* [[Oculopharyngeal muscular dystrophy]] is a genetic disease with palpebral [[ptosis (eyelid)|ptosis]], oropharyngeal dysphagia, and proximal limb weakness.
!Neurological
* Decrease in salivary flow, which can lead to dry mouth or [[xerostomia]], can be due to [[Sjogren's syndrome]], [[anticholinergics]], [[antihistamines]], or certain [[antihypertensives]] and can lead to incomplete processing of food bolus.
!Medication side effects
* [[Xerostomia]] can reduce the volume and increase the [[viscosity]] of oral secretions making [[Bolus (digestion)|bolus]] formation difficult as well as reducing the ability to initate and swallow the bolus<ref name="Murray"> </ref>
!Others
* Dental problems can lead to inadequate chewing.
|-
* Abnormality in oral mucosa such as from [[mucositis]], aphthous [[ulcer]]s, or [[Herpes simplex virus|herpetic lesions]] can interfere with [[Bolus (digestion)|bolus]] processing.
|
* Mechanical obstruction in the oropharynx may be due to malignancies, cervical rings or webs, or cervical [[osteophytes]].
* [[Stroke]]
* Increased upper esophageal sphincter tone can be due to [[Parkinson's disease]] which leads to incomplete opening of the UES. This may lead to formation of a [[Zenker's diverticulum]].
* [[Parkinson's disease]]
* [[Pharyngeal pouch]]es typically cause difficulty in swallowing after the first mouthful of food, with regurgitation of the pouch contents. These pouches are also marked by malodorous breath due to decomposing foods residing in the pouches. (See [[Zenker's diverticulum]])
* Occulopharyngeal dystrophy
* Dysphagia is often a side effect of surgical procedures like anterior [[cervical spine]] surgery, [[carotid endarterectomy]], head and neck resection, oral surgeries like removal of the tongue, and parietal laryngectomies <ref name="Murray"> </ref>
* [[Amyotrophic lateral sclerosis]]
* [[Radiotherapy]], used to treat head and neck cancer, can cause tissue [[fibrosis]] in the irradiated areas.  Fibrosis of [[tongue]] and [[larynx]] lead to reduced tongue base retraction and laryngeal elevation during swallowing<ref name="Murray"> </ref>
* [[Myasthenia gravis]]
* Infection may cause [[pharyngitis]] which can prevent swallowing due to [[Pain and nociception|pain]].
|
* Medications can cause [[central nervous system]] effects that can result in an oropharyngeal dysphagia.  Examples: [[sedatives]], hypnotic agents, [[anticonvulsants]], [[antihistamines]], [[neuroleptics]], [[barbiturates]], and antiseizure medication.  Medications can also cause [[peripheral nervous system]] effects resulting in an oropharyngeal dysphagia. Examples: [[corticosteroids]], [[L-tryptophan]], and [[anticholinergic]]s<ref name="Murray"> </ref>
* [[Sedatives]]  
* [[Hypnotics|Hypnotic agents]]
* [[Anticonvulsants]]
* [[Neuroleptics]]
* [[Antihistamines]]
* [[Barbiturates]]
* [[Antiepileptics]]
* [[Corticosteroids]]
* [[Tetracycline]]
* [[L-tryptophan]]
* [[Anticholinergics|Anticholinergics.]]
|
* [[Radiation therapy|Radiotherapy]] of the head and neck
* [[Pharyngitis]]
* Cervical web or rings
* Dental disease
* [[Oral candidiasis]]  
* [[Tetanus]]
* [[Lead poisoning]]
* [[Rabies]]
|}


===Common Causes of Esophageal Dysphagia===
===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>
* '''''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.
{| class="wikitable"
 
! colspan="4" |Structural (Mechanical) disorders
* '''''[[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.
! colspan="2" |Motor disorders
 
! rowspan="2" |Esophageal tumors
{{main|esophageal cancer}}
! rowspan="2" |Systemic diseases
 
! rowspan="2" |Miscellaneous
* '''''Esophageal rings and [[esophageal web|web]]s''''', are actual rings and webs of tissue that may occlude the esophageal lumen.
|-
 
! colspan="2" |'''Intrinsic compression'''
** ''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.
! colspan="2" |'''Extrinsic Compression'''
 
!'''Primary'''
** ''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]].
!'''Secondary'''
{{main|esophageal web}}
|-
 
|'''Mucosal rings and webs'''
* '''''[[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]]''.
* [[Schatzki ring|Schatzki]]
{{main|achalasia}}
* [[Plummer-Vinson syndrome|Plummer-Vinson]]
 
* Multiringed esophagus [[Eosinophilic esophagitis|(eosinophilic esophagitis]]) 
* '''''[[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.
|'''Strictures:'''
{{main|scleroderma}}
* [[Peptic ulcer|PUD]]
 
* [[Caustic]]
* '''''Spastic motility disorders''''' include [[diffuse esophageal spasm]] (DES), [[nutcracker esophagus]], hypertensive lower esophageal sphincter, and nonspecific spastic esophageal motility disorders (NEMD).
* Pill-induced
 
* Radiation-induced
** ''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.
|'''Vascular compression:'''
* Dysphagia lusoria (aberrant right subclavian artery)
* Dysphagia aortica (right-sided aorta)
* [[Cardiomegaly|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 mellitus|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|Crohn’s disease]]
|
* Postsurgery ([[Laryngeal cancer|laryngeal]], [[Esophageal cancer|esophageal]], or [[Stomach cancer|gastric cancers]])
* Acute [[Esophagitis|esophageal infections]]
* Esophageal diverticulae
* Foreign bodies
|}


* [[Diverticulum]]
===Less Common Causes===
* [[Aberrant subclavian artery]], or ([[Ortner's syndrome|dysphagia lusoria]])
Less common causes of dysphagia include:
* Cervical osteophytes
* 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>
* [[Enlarged aorta]]
* 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>
* [[Enlarged left atrium]]
* 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>
* [[Mediastinal tumor]]
* 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===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
The causes of dysphagia based on the organ system are as follows:<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
{| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
 
| style="width:75%" bgcolor="Beige" ; border="1" |[[Aberrant subclavian artery]], [[amyloidosis]], [[anomalous left pulmonary artery]],[[aortic aneurysm]], [[aortic arch anomalies]], [[CHARGE syndrome|charge syndrome]], [[double aortic arch]], [[enlarged aorta]], [[enlarged left atrium]], [[hypokalemia]], [[mitral valve stenosis]], [[pericarditis]], [[superior vena cava syndrome]]  
[[Aortic arch anomalies]],
aberrant [[subclavian artery]],
[[anomalous left pulmonary artery ]],
[[double aortic arch]],
large aneurysm of the thoracic aorta,
[[mitral stenosis]],
[[right aortic arch ]],
[[superior vena cava syndrome]],
[[thoracic aortic aneurysms]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[Arizona bark scorpion|Arizona bark scorpion poisoning]], [[arsenic poisoning]], [[botulism]], [[cobra poisoning]], [[fluoride poisoning]], [[lead poisoning]]
[[Arsenic poisoning]],
[[botulism]],
[[cyclosporine]] toxicity,  
[[fluoride poisoning]],
[[lead poisoning]],
 
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Behcet's syndrome]], [[dermatomyositis]], [[polymyositis]], [[Stevens-Johnson syndrome]], [[systemic lupus erythematosus]]  
[[Dermatomyositis]],
[[polymyositis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Antipsychotic drugs|Antipsychotic medications]], [[artemether and lumefantrin]], [[atropine]], [[botulinum toxin]], [[bicalutamide]][[chemotherapy]], [[Cyclosporine|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]]
 
Antipsychotic medications, [[Hyoscyamine]], [[Nabumetone]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Carcinoma of the vocal tract]], [[cricopharyngeal spasm]], [[Eagle syndrome|eagle syndrome]], [[epiglottitis]], [[Larynx|Impaired sensitivity in the larynx]], [[laryngeal cancer]], [[nasopharyngeal carcinoma]], [[Pharynx|oral pharyngeal disorders]], [[Oral submucous fibrosis|oral submucous fibrosis]], [[palatine tonsil]], [[pharyngeal pouch]], [[pharyngitis]], [[Head and neck cancer|pharynx cancer]], [[quinsy]], [[retropharyngeal abscess]], [[Tonsil cancer|tonsillar cancer]]
[[Palatine tonsil]],
[[pharyngeal pouch]],
[[pharyngitis]],
[[quinsy]],
[[retropharyngeal abscess]]
 
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Cushing's syndrome]], [[diabetic neuropathy]], [[goiter]], [[hyperthyroidism]], [[hypokalemia]], [[hypothyroidism]], [[paraganglioma]], [[Riedel thyroiditis]], [[subacute granulomatous thyroiditis]], [[thymoma]], [[thyroglossal cyst]], [[Thyroid cancer|thyroid cancer, anaplastic]],[[thyrotoxicosis]], [[vagal paraganglioma]], [[De Quervain's thyroiditis]], [[solitary thyroid nodule]]
[[De Quervain's thyroiditis]],
[[diabetic neuropathy]],
[[solitary thyroid nodule]],
[[thymoma]],
[[thyroglossal cyst]]
 
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Achalasia]], [[adjustable gastric band]], [[aerophagia]], [[aspiration of foreign body]], [[Barrett's esophagus|Barret's syndrome]],[[Candida esophagitis (patient information)|candida esophagitis]], [[Stomach|cascade stomach]], [[esophagitis|caustic esophagitis]], [[Crohn's disease|Crohn's disease of the esophagus]], [[diffuse esophageal spasm]], [[diverticulum]], [[eosinophilic esophagitis]], [[eosinophilic gastroenteritis]], [[esophageal atresia]], [[esophageal cancer]], [[esophageal cyst]], [[esophageal diverticulum]], [[Leiomyoma|esophageal leiomyoma]], [[Foreign body|esophageal obstruction by a foreign body]], [[esophageal pouch]], [[esophageal spasm]], [[esophageal stricture]], [[esophageal web]], [[esophageal moniliasis]], [[esophageal sarcoidosis]], [[Trauma|esophageal trauma]], [[esophagitis]], [[esophagotracheal fistula]], [[Esophagus|external esophageal compression]], [[gastric cancer]], [[gastric volvulus]], [[gastritis]], [[gastroesophageal reflux]], [[gastrointestinal stromal tumor]], [[gastroparesis]], [[Gaucher disease]], [[globus pharyngis]], [[globus syndrome]], [[hiatal hernia]], [[Nutcracker esophagus|hypertensive lower esophageal sphincter]], [[esophagitis|infectious esophagitis]], [[Esophageal intramural pseudodiverticulosis|intramural pseudodiverticulosis]], [[esophagitis|lymphocytic esophagitis]], [[mitochondrial neurogastrointestinal encephalopathy syndrome]], [[mucositis]], [[myoneurogastrointestinal encephalopathy syndrome]], [[nutcracker esophagus]], [[odynophagia]], [[peptic esophagitis]], [[Surgery|post surgery]], [[Esophageal stricture|peptic stricture]], [[pharyngeal pouch]], [[Esophagitis|pill esophagitis]], [[Plummer-Vinson syndrome]], [[presbyphagia]], [[pseudoachalasia]], [[pyloric stenosis]], [[radiation|radiation esophagitis]], [[Schatzki ring]], [[stomach cancer]], [[Esophagus|upper oesophageal sphincter dysfunction]], [[Wilson disease]], [[zenker's diverticulum]]
 
[[Barrett's esophagus]],
[[Plummer-Vinson syndrome]],
[[achalasia]],
[[adjustable gastric band]],
[[diffuse esophageal spasm]],
[[eosinophilic esophagitis]],
[[esophageal cancer]],
[[esophageal food bolus obstruction]],
[[esophageal foreign body]],
[[esophageal web]],
[[gastroesophageal reflux disease]],
[[gastrointestinal stromal tumor]],
[[globus pharyngis]],
[[hiatus hernia]],
hypertensive lower esophageal sphincter,
[[Ludwig's angina]],
lymphocytic esophagitis,
[[Nissen fundoplication]],
[[nutcracker esophagus]],
[[odynophagia]],
oropharyngeal cancer,
[[Ortner's syndrome]],
palate cancer,
[[palatine tonsil]],
[[pharyngeal pouch]],
[[pharyngitis]]
pill esophagitis,
post surgery (laryngeal, esophageal, gastric),
[[presbyphagia]],
[[pseudoachalasia]],
[[quinsy]],
radiation esophagitis/stricture,
[[retropharyngeal abscess]],
[[Schatzki ring]],
[[scleroderma]],
[[Wilson disease]],
[[Zenker's diverticulum]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Aberrant subclavian artery]], [[achalasia-addisonian syndrome]], [[achromatopsia]], [[adrenoleukodystrophy]], [[POLG|ataxia neuropathy spectrum]],[[Behcet's syndrome]], [[Chromosome 1, 1p36 deletion syndrome|chromosome 1p36 deletion syndrome]], [[Chromosome 22 (human)|chromosome 22 ring]], [[Trisomy 22|chromosome 22 trisomy mosaic]], [[Connective tissue disease|connective tissue disease]], [[CRLF1|crisponi syndrome]], [[Emanuel syndrome ]] , [[Spinal curvature|extreme spinal curvature]], [[Gaucher disease]],[[Huntington disease]],  [[Lissencephaly|lissencephaly, type 1, x-linked]] , [[muscular dystrophy, Duchenne and Becker type]] ,[[myotonic dystrophy]], [[Congenital myopathy|nemaline myopathy1]], [[oculopharyngeal muscular dystrophy]], [[Autosomal dominant opitz G/BBB syndrome|Opitz-frias syndrome]], [[ACOX1|pseudoadrenoleukodystrophy]], [[spinal muscular atrophy type I]], [[spinocerebellar ataxia 17 ]] , [[Spinocerebellar ataxia|spinocerebellar ataxia 22]], [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]], [[Schwartz–Jampel syndrome|Stuve-wiedemann dysplasia]],  [[Vascular ring|vascular ring with right aortic arch]], [[Wiedemann–Rautenstrauch syndrome]], [[Wilson disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Agranulocytosis]], [[mononucleosis]], [[Plummer-Vinson syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Abscess]], [[angina tonsillaris]], [[botulism]], [[Candida esophagitis (patient information)|candida esophagitis]], [[Chagas disease]], [[cytomegalovirus]], [[diphtheria]], [[epiglottitis]], [[gastritis]], [[herpangina]], [[herpes simplex virus]], [[esophagitis|infectious esophagitis]],[[laryngeal papillomatosis]], [[lassa fever]], [[Ludwig's angina]], [[lyme disease]], [[Lymphomatoid granulomatosis|lymph granulomatosis]], [[Lymphadenopathy]],[[esophagitis|Medication-induced esophagitis]], [[mumps]], [[neonatal tetanus ]] , [[oral candidiasis]], [[paracoccidioidomycosis]], [[Pharyngitis]], [[polio]], [[poliomyelitis]], [[Post-polio syndrome overview|postpolio syndrome]], [[quinsy]], [[rabies]], [[retropharyngeal abscess]], [[snakebites]], [[stomatitis]], [[syphilis]], [[tetanus]], [[tetrodotoxin]], [[tonsillar abscess]], [[ulcer]], [[Vincent's angina]]
[[Diphtheria]],
[[Lassa fever]],
[[rabies]],
[[snakebites]],
[[tetanus]],
[[tetrodotoxin]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |cytoplasmic body myopathy, [[Diffuse idiopathic skeletal hyperostosis]], [[distal myopathy 2]], [[elongated styloid process]], [[Spinal curvature|extreme spinal curvature]], [[inclusion body myositis]], [[muscular dystrophy, Duchenne and Becker type]], [[osteophytes]], [[Pierre Robin's sequence ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|  
| bgcolor="Beige" |[[10th cranial nerve disorder]], [[amyotrophic lateral sclerosis]], [[Arnold–Chiari malformation]], [[POLG|ataxia neuropathy spectrum]], [[Dysautonomia|autonomic nerve disorders]], [[autonomic neuropathy]], [[Hereditary spastic paraplegia|autosomal recessive spastic paraplegia, type 11]], [[Avellis syndrome]], [[Babinski–Nageotte syndrome]], [[basal ganglia disease]], [[basilar artery insufficiency syndrome]], [[brain stem gliomas]], [[brainstem stroke]], [[Brain stem tumor|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 syndrome|cerebellar stroke]], [[cerebral palsy]], [[cerebrovascular accident]], [[congenital myasthenic syndrome]], [[osteophytes|cervical osteophytes]], [[dementia]], [[diabetic neuropathy]], [[dystonia]], [[Ohtahara syndrome|epileptic encephalopathy, early infantile, 1]], [[Facial Onset Sensory Motor Neuropathy syndrome|fosmn syndrome]], [[Guillain-Barre Syndrome]], [[head trauma]], [[Huntington disease]], [[infantile striato-thalamic degeneration]], [[Lateral funiculus|lateral funiculus angina]], [[lateral medullary syndrome]], [[Jean Lhermitte |Lhermitte-cornil-quesnel syndrome]], [[Lissencephaly|lissencephaly, type 1, x-linked]], [[Encephalopathy classification|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]], [[Parkinson's disease|Pallidopyramidal syndrome]], [[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[Parkinson disease]], [[peripheral neuropathy]], [[Tongue|peripheral tongue paralysis]], [[polyradiculitis]], [[Pontocerebellar hypoplasia|pontocerebellar hypoplasia type 2a]], [[Primary lateral sclerosis|primary lateral sclerosis, adult]], [[Esophageal motility disorder|primary motility disorders]], [[Pseudobulbar paralysis]],[[pseudodysphagia]], [[Esophageal motility disorder|secondary motility disorders]], [[Shy-Drager syndrome]], [[Hereditary spastic paraplegia|spastic paraplegia 11, autosomal recessive]], [[spinal muscular atrophy type I]], [[Spinocerebellar ataxia|spinocerebellar ataxia 17]] , [[spinocerebellar ataxia|spinocerebellar ataxia 22]] , [[Spinocerebellar ataxia|spinocerebellar ataxia, autosomal recessive 1]], [[Striatonigral degeneration|striatonigral degeneration infantile]], [[stroke]], [[syringobulbia]], [[tardive dyskinesia]], [[vagus nerve|vagus nerve palsy]], [[Lateral medullary syndrome|Wallenberg's syndrome]]
 
[[Amyotrophic lateral sclerosis]],
[[autonomic neuropathy]],
[[brain stem]] [[gliomas]],
[[bulbar palsy]],
[[central pontine myelinolysis]],
[[cerebellar Infarction]],
[[Chagas' disease]],
[[Guillain-Barre syndrome]],
[[lateral medullary syndrome]],
[[multiple sclerosis]],
[[myasthenia gravis]],
[[myotonic dystrophy]],
[[osmotic demyelination syndrome]],
[[paraganglioma]],
[[Parkinson's disease]],
[[pseudobulbar palsy]],
[[pseudodysphagia]],
[[vagus nerve]] palsy,
Wallenbergs Syndrome
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Adrenoleukodystrophy]], [[amyloidosis]], [[Gaucher disease]], [[hydroxocobalamin]], [[hypokalemia]], [[Plummer-Vinson syndrome]], [[Wilson disease]]  
[[Plummer-Vinson syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Leiomyoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Acoustic neuroma]], [[Brain Stem Gliomas|brain stem gliomas]], [[Brain stem tumor|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]], [[Head and neck cancer |neck cancer]], [[odontoma]], [[Oral cancer|Oral cavity tumor]], [[oropharyngeal cancer]], [[Oral cancer|palate cancer]], [[paraganglioma]], [[paraneoplastic limbic encephalitis]], [[paraneoplastic syndrome]], [[Head and neck cancer|pharynx cancer]], [[small cell lung cancer]], [[stomach cancer]], [[supraglottic laryngeal cancer]], [[Head and neck cancer|throat cancer]], [[Anaplastic thyroid cancer|thyroid cancer, anaplastic]], [[tongue cancer]], [[tonsil cancer|tonsillar cancer]], [[vagal paraganglioma]]  
Brain  stem gliomas,
[[esophageal cancer]],
oropharyngeal cancer,
palate cancer,
[[lung cancer]],
[[malignant mesothelioma]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Achromatopsia]], [[oculopharyngeal muscular dystrophy]]
 
[[Oculopharyngeal muscular dystrophy]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Alcoholism]]  
[[Arsenic poisoning]],
[[fluoride poisoning]],
[[lead poisoning]],
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Anxiety disorders]], [[dementia]], [[frontotemporal dementia]], [[functional disorders]], [[global hystericus]], [[rumination disorder]], [[tardive dyskinesia]]
Functional Dysphagia
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Bronchial carcinoma]], [[Bronchogenic cyst|congenital bronchogenic cyst]], [[epiglottitis]], [[malignant lung cancer]], [[malignant mesothelioma]][[mediastinal mass]], [[mediastinitis]], [[Ondine's curse]], [[pharyngitis]], [[pleuritis]], [[sarcoidosis]]
[[Lung cancer]],
[[malignant mesothelioma]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Hypomagnesemia|Hypomagnesemia primary]], [[hypophosphatemia]], [[systemic lupus erythematosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Allergic swelling]], [[amyloidosis]], [[Behcet's syndrome]], Canomad syndrome, [[bone spur|cervical osteophytes]], [[CREST syndrome]], [[dermatomyositis]], [[Systemic scleroderma|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]]  
 
Cervical osteophytes,
[[inclusion body myositis]],
[[juvenile dermatomyositis]],
[[muscular dystrophy]],
[[oculopharyngeal muscular dystrophy]],
[[polymyalgia Rheumatica]],
[[polymyositis]],
[[trismus]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Head trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" |[[Vincent's angina]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | Franek-bocker-kahlen syndrome,  [[palatoplegia]], [[Tongue disease|tongue conditions]], [[Vascular anomaly|vascular abnormality]]
 
|-
|-
|}
|}
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
{{MultiCol}}
* [[Abscess]]
* [[Achalasia]]
* [[Aerophagia]]
* [[Agranulocytosis]]
* [[Alcoholism]]
* [[Allergic]] swelling
* [[Amyloidosis]]
* [[Amyotrophic Lateral Sclerosis]] ([[ALS]])
* Angina tonsillaris
* [[Anxiety]] disorders
* [[Aortic aneurysm]]
* Aspiration of foreign body
* [[Barret's Syndrome]]
* [[Behcet's Syndrome]]
* [[Botulism]]
* [[Brainstem]] [[stroke]]
* [[Bronchial carcinoma]]
* [[Bulbar palsy]]
* [[Candidiasis]]
* Cascade stomach
* Central [[hypoglossal nerve]] paralysis
* Central vagal nucleus lesion
* [[Cerebrovascular accident]] ([[CVA]])
* [[Chagas Disease]]
* Chemical [[burns]]
* [[CREST syndrome]]: ([[calcinosis]], [[raynaud's phenomenon]], [[esophageal]] dysmotility, [[sclerodactyly]], [[telangiectasias]])
* [[Cytomegalovirus]] ([[CMV]])
* [[Dermatomyositis]]
* [[Diabetic neuropathy]]
* [[Diphtheria]]
* [[Diverticulum]]
* [[Left Atrial Enlargement|Enlarged left atrium]]
* [[Esophageal cancer]]
* Esophageal [[Crohn's disease]]
* [[Esophageal diverticulum]]
* Esophageal [[moniliasis]]
* Esophageal [[sarcoidosis]]
* [[Esophageal spasm]]
* Esophageal [[trauma]]
* [[Esophagotracheal fistula]]
* Extreme spinal curvature
* [[Fibrosis]]
* Food bolus
* [[Gastric cancer]]
* [[Gastritis]]
* [[Gastroparesis]]
* [[Global hystericus]]
* [[Globus syndrome]]
* [[Goiter]]
* [[Graft-versus-host disease]]
* [[Guillain-Barre Syndrome]]
* [[Herpangina]]
* [[Herpes simplex virus]] ([[HSV]])
{{ColBreak}}
* [[Hiatal hernia]]
* [[Huntington's chorea]]
* [[Hyperthyroidism]]
* [[Hypokalemia]]
* [[Hypothyroidism]]
* Idiopathic [[human immunodeficiency virus]][[HIV]] [[ulcer]]s
* Impaired sensitivity in the [[larynx]]
* Intramural pseudodiverticulosis
* [[Laryngeal cancer]]
* [[Lateral funiculus]] [[angina]]
* [[Leiomyoma]]
* [[Ludwig's angina]]
* Lymph granulomatosis
* [[Lymphadenopathy]]
* Medication-induced [[esophagitis]]
* [[Mononucleosis]]
* [[Multiple Sclerosis]]
* [[Mumps]]
* [[Myasthenia Gravis]]
* [[Neoplastic]] (external compression)
* [[Nutcracker esophagus]]
* [[Oral candidiasis]]
* [[Osteophytes]]
* [[Palatoplegia]] after damage to the [[vagal nerve]] or the accessory nerve
* [[Paraneoplastic syndrome]]
* [[Parkinson's Disease]]
* [[Pericarditis]]
* [[Peripheral neuropathy]]
* Peripheral tongue paralysis with lesions of the [[hypoglossal nerve]]
* [[Pharyngitis]]
* [[Pleuritis]]
* [[Plummer-Vinson Syndrome]]
* [[Poliomyelitis]]
* [[Polyradiculitis]]
* [[Pseudoachalasia]]
* [[Pseudobulbar paralysis]]
* [[Pyloric stenosis]]
* [[Rabies]]
* [[Radiation esophagitis]]
* [[Reflux esophagitis]]
* [[Rheumatoid Arthritis]]
* [[Scarlet Fever]]
* [[Schatzki ring]]
* [[Scleroderma]]
* [[Stevens-Johnson Syndrome]]
* [[Stomatitis]]
* [[Syringobulbia]]
* [[Systemic Lupus Erythematosus]]
* [[Tetanus]]
* Tonsillar [[abscess]]
* [[Typhoid fever]] angina
* Vascular abnormality
* [[Vincent's angina]]
* [[Zenker's Diverticulum]]
{{EndMultiCol}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs overview]]
{{WH}}
[[Category:Needs content]]
{{WS}}
 
[[Category:Crowdiagnosis]]
[[Category:Geriatrics]]
[[Category:Geriatrics]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Signs and symptoms]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 21:30, 29 July 2020

Dysphagia Microchapters

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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

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
Mucosal rings and webs Strictures: Vascular compression:
  • Dysphagia lusoria (aberrant right subclavian artery)
  • Dysphagia aortica (right-sided aorta)
  • Cardio-megaly (enlarged left atrium)

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, bicalutamidechemotherapy, cyclosporine toxicity, cytarabine, dactinomycin, doxycycline, eletriptan, hydroxocobalaminhyoscyamine, 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 mesotheliomamediastinal 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

  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.
  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.
  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.
  4. ↑ Roman S, Kahrilas PJ (2014). "The diagnosis and management of hiatus hernia". BMJ. 349: g6154. doi:10.1136/bmj.g6154. PMID 25341679.
  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.
  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.
  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.
  8. ↑ Pandolfino JE, Gawron AJ (2015). "Achalasia: a systematic review". JAMA. 313 (18): 1841–52. doi:10.1001/jama.2015.2996. PMID 25965233.
  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.
  10. ↑ Chatterjee S, Hedman BJ, Kirby DF (2017). "An Unusual Cause of Dysphagia". J Clin Rheumatol. doi:10.1097/RHU.0000000000000666. PMID 29280826.
  11. ↑ Wright RA, Bernie H (1982). "Scleredema adultorum of Buschke with upper esophageal involvement". Am J Gastroenterol. 77 (1): 9–11. PMID 7064968.
  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.
  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.
  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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