Dysphagia
Basics
Description
Description
- Difficulty swallowing
- Can be neuromuscular, mechanical, infectious, inflammatory, or extrinsic to aerodigestive system
- Difficulty may be with solids, liquids, or both
Etiology
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
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Dysphagia." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia.
Dysphagia. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia. Accessed November 14, 2024.
Dysphagia. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia
Dysphagia [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307387/all/Dysphagia.
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