Dysphagia resident survival guide: Difference between revisions
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❑[[Oropharyngeal dysphagia]] | ❑[[Oropharyngeal dysphagia]] | ||
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:❑[[Heartburn]] (seen in [[peptic stricture]], [[scleroderma]] and others</div>}} | :❑[[Heartburn]] (seen in [[peptic stricture]], [[scleroderma]] and others</div>}} | ||
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{{familytree | {{familytree | | | B01 | | | B01=<div style="float: left; text-align: left; width: 35em; padding:1em;">'''Obtain a detailed history'''<br> | ||
❑Past Medical History<br> | ❑Past Medical History<br> | ||
:❑Recent [[stroke]] <br> | :❑Recent [[stroke]] <br> | ||
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{{familytree | {{familytree | | | C01 | | | C01=<div style="float: left; text-align: left; width: 35em; padding:1em;">'''Examine the patient:'''</div>}} | ||
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Revision as of 14:37, 5 August 2020
Dysphagia Resident Survival Guide |
---|
Overview |
Causes |
Diagnosis |
Treatment |
Do's |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. There are no known life-threatening causes of dysphagia.
Common Causes
Depending upon the type of dysphagia, the causes can be categorized into two subsections:[1][2][3][4][5][6]
Common Causes of Oropharyngeal Dysphagia
Common causes of oropharyngeal dysphagia | |||
---|---|---|---|
Neuromuscular disorders | Mechanical and obstructive causes | Medication side effects | Others |
|
Medications that reduce salivary flow:
|
|
Common Causes of Esophageal Dysphagia
The common causes of esophageal dysphagia can be divided into four categories.[7][8][9][10][11]
Structural (Mechanical) disorders | Motor disorders | Esophageal tumors | Systemic diseases | Miscellaneous | ||||
---|---|---|---|---|---|---|---|---|
Intrinsic compression | Extrinsic Compression | Primary | Secondary | |||||
Mucosal rings and webs
|
Strictures: | Vascular compression:
|
|
|
|
|
Less Common Causes
Less common causes of dysphagia include:
- Scleredema adultorum[12][13]
- Post chemotherapy and radiation therapy[14]
- Descending thoracic aorta aneurysm[15]
- Hypertrophy of cricopharyngeal muscles[16]
To review a complete list of dysphagia causes, click here
Diagnosis
Characterize the symptoms:
| |||||||||||||||||||
Obtain a detailed history ❑Past Medical History
❑Medication history
❑Social History
| |||||||||||||||||||
Examine the patient: | |||||||||||||||||||
Patient with Dysphagia | |||||||||||||||||||||||||||||||||
Difficulty in initiating a swallow associated with cough, choking or nasal regurgitation | Dysphagia to solids and liquids, or solids, sensation of food stuck in esophagus (seconds after initiating swallow) | ||||||||||||||||||||||||||||||||
Oropharyngeal dysphagia | Esophageal dysphagia | ||||||||||||||||||||||||||||||||
Shown below is an algorithm summarizing the diagnosis of Oropharyngeal dysphagia according to the the World Gastroenterology Organisation Global Guidelines, International consensus (ICON) on assessment of oropharyngeal dysphagia and AGA technical review on management of oropharyngeal dysphagia.[1][4][2]
Dysphagia | |||||||||||||||||||||||||||||||||||||||||
History and Physical examination | Identify alternate diagnoses such as xerostomia, globus, esophageal dysphagia | ||||||||||||||||||||||||||||||||||||||||
Laboratory findings and CNS imaging | Identify syndromes with specific treatment such as myasthenia gravis, toxic and metabolic myopathies, CNS tumors | ||||||||||||||||||||||||||||||||||||||||
No systemic disease identified | Neuromuscular disorders without specific treatment | ||||||||||||||||||||||||||||||||||||||||
Nasoendoscopy (to evaluate for structural causes of dysphagia) | |||||||||||||||||||||||||||||||||||||||||
Videofluoroscopic swallowing +/-manometry (to characterise severity and mechanism of swallow dysfunction) | |||||||||||||||||||||||||||||||||||||||||
Structural lesions with specific therapy such as zenker's diverticulum, orophayngeal tumors | Severe dysfunction or risk of aspiration pneumonia necessitating the institution of nonoral feeding, tracheostomy | Dysphagia ammendable to cricophayngeal myotomy | Dysphagia ammendable to specific therapy (diet modification, swallow therapy +/- temporary nonoral feeding) | ||||||||||||||||||||||||||||||||||||||
Shown below is an algorithm summarizing the diagnosis of Esophageal dysphagia according the the World Gastroenterology Organisation Global Guidelines, and Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia.[1][6]
Esophageal dysphagia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dysphagia to solids and liquids | Dysphagia to solids (may progress to liquids) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Motility disorders | Mechanical obstruction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intermittent | Progressive | Acute | Intermittent | Progressive | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chronic heartburn | Regurgitation and/or respiratory symptoms | Chronic heartburn | Elderly (>50 years), weight loss, anemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Primary motility disorders | Secondary motility disorders | Scleroderma | Achalasia | Foreign body | Esophageal or cardia carcinomas | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Manometry | Endoscopy (+/-esophageal biopsy) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Barium Swallow indicated when: • Endoscopy findings are normal • Endoscopy is contraindicated due to history of surgery for esophageal/laryngeal cancer or history of radiation or caustic injury, complex stricture or risk of perforation • Endoscopy access is limited | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of Oropharyngeal dysphagia according to the the World Gastroenterology Organisation Global Guidelines, International consensus (ICON) on assessment of oropharyngeal dysphagia and AGA technical review on management of oropharyngeal dysphagia.[1][4][2]
Systemic disease with specific therapy such as myasthenia gravis, myopathies, parkinson's disease, infections and others | Treat the underlying disease | ||||||||||||||||||||||||||||||||||||||||||||||||||
CNS tumors and oropharyngeal tumors | Surgical resection, chemotherapy or radiotherapy | ||||||||||||||||||||||||||||||||||||||||||||||||||
Oropharyngeal dysphagia | Structural disorders such as cervical webs and rings, zenker's diverticulum and others | Treatment of the disorder | |||||||||||||||||||||||||||||||||||||||||||||||||
Medication side effects | Discontinue medication | ||||||||||||||||||||||||||||||||||||||||||||||||||
Severe dysfunction and risk of aspiration pneumonia | • Non-oral feeding • Tracheostomy | ||||||||||||||||||||||||||||||||||||||||||||||||||
Neuromuscular disorder without specific therapy such as stroke, dengerative diseases and others | Cricopharynegal dysfunction | Cricopharyngeal myotomy | |||||||||||||||||||||||||||||||||||||||||||||||||
Rehabilitation | |||||||||||||||||||||||||||||||||||||||||||||||||||
Shown below is an algorithm summarizing the management of Esophageal dysphagia according the the World Gastroenterology Organisation Global Guidelines, and Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia.[1][6]
Esophageal dysphagia | |||||||||||||||||||||||||||||||||||||||||
Age>50 years, weight loss, anemia and other alarm signs and symptoms | Endoscopy +/- other imaging studies | Surgical resection or chemotherapyof the detected esophageal carcinoma | |||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||
GERD symptoms | Proton pump inhibitor trial for 4 weeks | ||||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||
Dysphagia unresolved | |||||||||||||||||||||||||||||||||||||||||
Structural or inflammatory lesions detected on endoscopy and/or barium swallow | Treat the detected lesions | ||||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||
Esophageal manometry | Treat the detected motility disorders | ||||||||||||||||||||||||||||||||||||||||
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Malagelada, Juan-R.; Bazzoli, Franco; Boeckxstaens, Guy; De Looze, Danny; Fried, Michael; Kahrilas, Peter; Lindberg, Greger; Malfertheiner, Peter; Salis, Graciela; Sharma, Prateek; Sifrim, Daniel; Vakil, Nimish; Le Mair, Anton (2015). "World Gastroenterology Organisation Global Guidelines". Journal of Clinical Gastroenterology. 49 (5): 370–378. doi:10.1097/MCG.0000000000000307. ISSN 0192-0790.
- ↑ 2.0 2.1 2.2 Cook, Ian J.; Kahrilas, Peter J. (1999). "AGA technical review on management of oropharyngeal dysphagia". Gastroenterology. 116 (2): 455–478. doi:10.1016/S0016-5085(99)70144-7. ISSN 0016-5085.
- ↑ Philpott, Hamish; Garg, Mayur; Tomic, Dunya; Balasubramanian, Smrithya; Sweis, Rami (2017). "Dysphagia: Thinking outside the box". World Journal of Gastroenterology. 23 (38): 6942–6951. doi:10.3748/wjg.v23.i38.6942. ISSN 1007-9327.
- ↑ 4.0 4.1 4.2 Espitalier, F.; Fanous, A.; Aviv, J.; Bassiouny, S.; Desuter, G.; Nerurkar, N.; Postma, G.; Crevier-Buchman, L. (2018). "International consensus (ICON) on assessment of oropharyngeal dysphagia". European Annals of Otorhinolaryngology, Head and Neck Diseases. 135 (1): S17–S21. doi:10.1016/j.anorl.2017.12.009. ISSN 1879-7296.
- ↑ Abdel Jalil, Ala' A.; Katzka, David A.; Castell, Donald O. (2015). "Approach to the Patient with Dysphagia". The American Journal of Medicine. 128 (10): 1138.e17–1138.e23. doi:10.1016/j.amjmed.2015.04.026. ISSN 0002-9343.
- ↑ 6.0 6.1 6.2 Liu, Louis W C; Andrews, Christopher N; Armstrong, David; Diamant, Nicholas; Jaffer, Nasir; Lazarescu, Adriana; Li, Marilyn; Martino, Rosemary; Paterson, William; Leontiadis, Grigorios I; Tse, Frances (2018). "Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia". Journal of the Canadian Association of Gastroenterology. 1 (1): 5–19. doi:10.1093/jcag/gwx008. ISSN 2515-2084.
- ↑ 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.