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Dysphagia

Dysphagia is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Difficulty swallowing
  • Can be neuromuscular or mechanical

Etiology

  • 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
  • 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 (disk 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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Citation

Rosen, Peter, et al., editors. "Dysphagia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia.
Dysphagia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia. Accessed April 26, 2019.
Dysphagia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia
Dysphagia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dysphagia ID - 307387 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -