Dysphagia history and symptoms

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

Symptoms of Oropharyngeal Dysphagia

Type of food		Progressive/intermittent	Associated symptoms
			Weight loss Anemia Heartburn Regurgitation of food particles

Symptoms in Adults may Include:

• Hesitation or inability to swallow
• Difficult or painful swallowing
• Constant feeling of a lump in the throat
• Inability to recognize food and taste it
• Food sticking in the throat
• Food coming up (regurgitation) through the throat or nose
• Chest pain or discomfort when swallowing
• Difficulty swallowing solid foods
• Frequent, repetitive swallowing
• Excessive throat clearing
• "Gurgly" sounding voice after eating
• Hoarse voice or recurrent sore throat
• Coughing during or after swallowing
• Necessity to "wash down" solid foods
• Recurrent episodes of pneumonia
• Frequent heartburn
• Food or stomach acid backing up into your throat (acid reflux)
• Unexpected weight loss

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).

In Infants and Children, Symptoms may Include:

• Low interest in feeding or meals
• 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.