Cardinal Symptoms in the Gastroenterology: Dysphagia (swallowing problems, Difficulty Swallowing) | Definition, Symptoms and causes

Definition

It means distressed swallow act as a result of many conditions, there are – according to the site of the disturbance two types of dysphagia:

Source: sacent.com

Oropharyngeal

mostly coordination problem of the upper esophageal sphincter

Causes:

Cerebral:

• Ischemia
• Bulbar/ pseudobulbar paralysis
• Polyneuropathy
• Parkinson
• Multiple sclerosis

Tumors: of the tongue and pharynx

Muscular:

• Myasthenia gravis
• Muscle dystrophy

Iatrogenic: after operations of the neck

Zenker's diverticulum

Esophageal

mostly mechanical Stenosis:

Mechanical

• 65%
• Esophageal carcinoma: the most common cause of older patients
• Mediastinal tumors: lymphomas
• Spinal osteophytes
• Webs (Plummer Vinson syndrome)
• Peptic stenosis

Neuromuscular

• 15%  (+ reflux esophagitis) the most common cause by younger patients
• Achalasia
• Hypercontractile Oesophagus
• Kollagenosen: dermatomyosclerosis

Epithelial lesions

• 15%
• Ulcerations (reflux esophagitis, Barret-Ulcus, Crohn, medicament induced)
• CMV
• Candidiasis
• Eosinophil esophagitis

Pseudo dysphagia (without organic lesions)

Diagnosis

1. Clinical anamneses:

• Is the swallow distress by hard or soft food or both? Carcinoma, motoric
• Will it increase by continuing eating? Diverticula
• Is it of weeks, years? Tumors, achalasia
• Are there other symptoms: wright Los? Pain? Etc …
• Endoscopic diagnostic: tumors? Webs? Ulcerations? Esophagitis?

2. Gastroscopy + biopsies

3. Motoric diagnosis: Esophageal manometry: achalasia, hypercontractile esophagus

4. Esophageal PH-metry: Reflux?

5. Barium swallow: achalasia? Diverticula?

Source: Duale Reihe: innere Medicine: 3 Auflage