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
0 Comments