Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

Dysphagia 513

➣useful for evaluation of oropharyngeal, extrinsic or intrinsic

anatomic causes, or in some cases motility causes of symptoms

■Endoscopy

➣evaluation of mucosa, biopsy strictures/masses, and dilate/stent

strictures.

■Manometry

➣evaluation of motility disorders

■Endoscopic ultrasound or CT scan

➣staging malignancy

differential diagnosis

■Oropharyngeal dysphagia

➣Inability to initiate swallow, worse with liquids

➣Difficult transfer of food to upper esophagus.

➣Associated with nasal regurgitation, coughing, nasal speech due

to palate weakness, neuromuscular diseases

■Esophageal dysphagia

➣Sticking sensation with swallow

➣Progressive symptoms (obstruction) vs. intermittent (motility

disorder or ring/web)

➣Solid (mechanical obstruction) vs. solids/liquids (motility or

severe mechanical obstruction)

➣Constant: extrinsic compression (vascular anomalies, thoracic

aortic aneurysm compression, cervical hypertrophic osteo-

arthropathy, lymphadenopathy, goiter)

management

What to Do First

■thorough symptom survey to direct tests seeking either anatomic or

functional abnormalities

General Measures

■smaller meals, changing food consistency, drinking liquids during

meals

■antireflux medications

■specific treatment according to diagnosis

■gastrostomy tube may be required when calorie intake is inadequate

specific therapy

Oropharyngeal causes

■thickened fluids; gastrostomy tube