• Difficulty swallowing
  • Can be neuromuscular, mechanical, infectious, inflammatory, or extrinsic to aerodigestive system
  • Difficulty may be with solids, liquids, or both


  • Oropharyngeal (transfer) dysphagia:
    • Difficulty transferring from the mouth to the proximal esophagus (difficulty initiating a swallow)
    • Easier to swallow solids vs. liquids
    • Immediate, within seconds of swallowing
    • Associated with nasal or oral regurgitation, coughing, or choking
    • Usually a neuromuscular disorder resulting in bulbar muscle weakness or impaired coordination
  • Esophageal (transport) dysphagia:
    • Failure of normal transit through the esophagus
    • Retrosternal sticking sensation seconds after swallowing
    • Nocturnal regurgitation/aspiration
    • Drooling or regurgitation of undigested food and liquid (characteristic of esophageal obstruction)
    • Motility disorder vs. mechanical obstruction
  • Functional dysphagia:
    • Diagnosis of exclusion
    • Full workup without evidence of mechanical or neuromuscular pathology
    • Symptoms >12 wk
  • Odynophagia:
    • Pain with swallowing
    • Separate, but often related, entity
    • Causes include infectious, medication-induced, and inflammatory conditions
  • Pain pattern:
    • Overall poor ability to localize pain with dysphagia, although oropharyngeal source is better
    • Somatic nerve fibers in the upper esophagus; better pain localization
    • Visceral pain from the lower esophagus is poorly localized and may be difficult to distinguish from that of acute coronary syndrome

Pediatric Considerations
  • Pediatric dysphagia:
    • Common causes in infants/newborns include prematurity, congenital malformations, neuromuscular disease, infection (e.g., candidiasis), inflammation
    • Always consider foreign body aspiration in a child presenting with dysphagia
    • Other common causes in children include caustic ingestions, infections, and neurologic disorders including sequelae from head injury
    • Acquired tracheoesophageal fistula in children may result from ingestions (button battery, caustic ingestions) or prior surgery
    • Other life-threatening causes of dysphagia include epiglottitis, retropharyngeal abscess, CNS infection, botulism, esophageal perforation, diphtheria

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