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{{Dysphagia}}
{{Dysphagia}}


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{{CMG}}{{AE}}{{FT}}
==Overview==
The most important factor in the evaluation of all types of dysphagia is a detailed history, and a thorough review of symptoms that can differentiate esophageal from oropharyngeal dysphagia and help predict the specific etiology. How a patient describes the symptoms and their timing, associated historical features, and other characterizations may specifically denote the anatomic level of swallowing dysfunction.


{{CMG}}
== History ==
Obtaining the history is the most important aspect of making a [[diagnosis]] of dysphagia. It provides insight into the [[Causality|cause]], precipitating factors and associated [[comorbid]] conditions. Specific points to focus in history of patient presenting with dysphagia include
* Past Medical History
** Recent [[stroke]] 
** [[Neuromuscular disease]]
** [[Hypertension]]
** [[Diabetes mellitus]] (DM)
** [[Thyroid disease]]
** [[Cancer]]


==History==
* Medication history
**History of use of any medications such as:
***[[Hypnotics|Hypnotic agents]]
***[[Anticonvulsants]]
***[[Neuroleptics]]
***[[Antihistamines]]
***[[Barbiturates]]
***[[Antiepileptics]]
* Social History
** History of [[alcohol]] and [[smoking]]
* Travel history ([[Chagas disease|Chaga's disease]])


==Symptoms of Oropharyngeal Dysphagia==
==Symptoms of Dysphagia==
===Symptoms in adults may include:===


*Hesitation or inability to swallow
=== Common symptoms ===
*Difficult or painful swallowing
Common symptoms of dysphagia include:<ref name="pmid2589590">{{cite journal| author=Jamieson J, Hinder RA, DeMeester TR, Litchfield D, Barlow A, Bailey RT| title=Analysis of thirty-two patients with Schatzki's ring. | journal=Am J Surg | year= 1989 | volume= 158 | issue= 6 | pages= 563-6 | pmid=2589590 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2589590  }} </ref><ref name="pmid7429120">{{cite journal| author=Hendrix TR| title=Schatzki ring, epithelial junction, and hiatal hernia--an unresolved controversy. | journal=Gastroenterology | year= 1980 | volume= 79 | issue= 3 | pages= 584-5 | pmid=7429120 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7429120  }} </ref><ref name="pmid25085338">{{cite journal| author=Bakari G, Benelbarhdadi I, Bahije L, El Feydi Essaid A| title=Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience. | journal=Gastrointest Endosc | year= 2014 | volume= 80 | issue= 4 | pages= 738-41 | pmid=25085338 | doi=10.1016/j.gie.2014.05.332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25085338  }} </ref><ref name="pmid26944249">{{cite journal| author=Bakshi SS| title=Plummer-Vinson Syndrome. | journal=Mayo Clin Proc | year= 2016 | volume= 91 | issue= 3 | pages= 404 | pmid=26944249 | doi=10.1016/j.mayocp.2015.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26944249  }} </ref><ref name="pmid12858606">{{cite journal| author=Lind CD| title=Dysphagia: evaluation and treatment. | journal=Gastroenterol Clin North Am | year= 2003 | volume= 32 | issue= 2 | pages= 553-75 | pmid=12858606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12858606  }} </ref><ref name="NavaneethanEubanks2015">{{cite journal|last1=Navaneethan|first1=Udayakumar|last2=Eubanks|first2=Steve|title=Approach to Patients with Esophageal Dysphagia|journal=Surgical Clinics of North America|volume=95|issue=3|year=2015|pages=483–489|issn=00396109|doi=10.1016/j.suc.2015.02.004}}</ref>
*Constant feeling of a lump in the throat
{| class="wikitable"
*Inability to recognize food and taste it
! colspan="2" |Symptoms
*Food sticking in the [[throat]]
|-
*Food coming up ([[regurgitation]]) through the throat or nose
!Oropharyngeal dysphagia
*[[Chest pain]] or discomfort when swallowing
!Esophageal dysphagia
*Difficulty swallowing solid foods
|-
*Frequent, repetitive swallowing
|
*Excessive throat clearing
* [[Cough|Coughing]] or [[choking]] with swallowing
*"Gurgly" sounding voice after eating
* Difficulty initiating swallowing
*[[Hoarse voice]] or recurrent sore throat
* Food sticking in the throat
*Coughing during or after swallowing
* [[Sialorrhea]]
*Necessity to "wash down" solid foods
* Unexplained [[weight loss]]
*Recurrent episodes of [[pneumonia]]
* Change in dietary habits
*Frequent [[heartburn]]
* [[Pneumonia|Recurrent pneumonia]]
*Food or stomach acid backing up into your throat ([[acid reflux]])
* Change in voice or speech
*Unexpected [[weight loss]]
* Nasal regurgitation
|
* Sensation of food sticking in the chest or throat
* Change in dietary habits
* Recurrent [[pneumonia]] 
* Symptoms of gastroesophageal reflux disease ([[GERD]]) including
** [[Heartburn]]
** [[Belching]]
** Sour [[regurgitation]], and water brash
|}


When asked where the food is getting stuck patients will often point to the [[cervical]] (neck) region as the site of the obstruction. However, this may be misleading due to patients' inaccurate sensation of the site of obstruction (with obstructions / dysmotilities lower in the esophagus being common).
=== Less common symptoms  ===
Less common symptoms of dysphagia include:
* [[Weight loss]]


===In infants and children, symptoms may include:===
* [[Anemia]]


*Low interest in feeding or meals
* [[Heartburn]]
*Tension in the body while feeding
*Refusal to eat foods that have certain textures
*Lengthy feeding or eating times (30 minutes or longer)
*Food or liquid leaking from the mouth
*[[Coughing]] or gagging when eating or nursing
*Spitting up or vomiting during feeding or meals
*Strained breathing while eating and drinking
*Poor weight gain or growth
 
==Symptoms of Esophageal Dysphagia==
Patients usually experience food getting stuck ''several seconds'' after swallowing, and will point to the suprasternal notch or behind the sternum as the site of obstruction. If there is dysphagia to both solids and liquids, then it is most likely a motility problem. If there is dysphagia initially to solids but progresses to also involve liquids, then it is most likely a mechanical obstruction. Once a distinction has been made between a motility problem and a mechanical obstruction, it is important to note whether the dysphagia is intermittent or progressive. An intermittent motility dysphagia likely can be [[diffuse esophageal spasm]] (DES) or nonspecific esophageal motility disorder (NEMD). Progressive motility dysphagia disorders include [[scleroderma]] or [[achalasia]] with chronic heartburn, regurgitation, respiratory problems, or weight loss. Intermittent mechanical dysphagia is likely to be an esophageal ring. Progressive mechanical dysphagia is most likely due to peptic stricture or [[esophageal cancer]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Needs overview]]
[[Category:Needs content]]
[[Category:Needs content]]
 
[[Category:Geriatrics]]
{{WH}}
[[Category:Gastroenterology]]
{{WS}}
[[Category:Otolaryngology]]

Latest revision as of 21:30, 29 July 2020

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

Overview

The most important factor in the evaluation of all types of dysphagia is a detailed history, and a thorough review of symptoms that can differentiate esophageal from oropharyngeal dysphagia and help predict the specific etiology. How a patient describes the symptoms and their timing, associated historical features, and other characterizations may specifically denote the anatomic level of swallowing dysfunction.

History

Obtaining the history is the most important aspect of making a diagnosis of dysphagia. It provides insight into the cause, precipitating factors and associated comorbid conditions. Specific points to focus in history of patient presenting with dysphagia include

Symptoms of Dysphagia

Common symptoms

Common symptoms of dysphagia include:[1][2][3][4][5][6]

Symptoms
Oropharyngeal dysphagia Esophageal dysphagia

Less common symptoms

Less common symptoms of dysphagia include:

References

  1. ↑ Jamieson J, Hinder RA, DeMeester TR, Litchfield D, Barlow A, Bailey RT (1989). "Analysis of thirty-two patients with Schatzki's ring". Am J Surg. 158 (6): 563–6. PMID 2589590.
  2. ↑ Hendrix TR (1980). "Schatzki ring, epithelial junction, and hiatal hernia--an unresolved controversy". Gastroenterology. 79 (3): 584–5. PMID 7429120.
  3. ↑ Bakari G, Benelbarhdadi I, Bahije L, El Feydi Essaid A (2014). "Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience". Gastrointest Endosc. 80 (4): 738–41. doi:10.1016/j.gie.2014.05.332. PMID 25085338.
  4. ↑ Bakshi SS (2016). "Plummer-Vinson Syndrome". Mayo Clin Proc. 91 (3): 404. doi:10.1016/j.mayocp.2015.11.002. PMID 26944249.
  5. ↑ Lind CD (2003). "Dysphagia: evaluation and treatment". Gastroenterol Clin North Am. 32 (2): 553–75. PMID 12858606.
  6. ↑ Navaneethan, Udayakumar; Eubanks, Steve (2015). "Approach to Patients with Esophageal Dysphagia". Surgical Clinics of North America. 95 (3): 483–489. doi:10.1016/j.suc.2015.02.004. ISSN 0039-6109.

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