Dysphagia means difficulty moving food or liquid from the mouth to the hypopharynx or through the esophagus. It is a symptom rather than a diagnosis, and the first useful question is where in the swallow the trouble lies.
Several terms are used alongside dysphagia:
- Aphagia — complete inability to swallow, due to esophageal obstruction.
- Odynophagia — painful swallowing, caused by mucosal ulceration or inflammation of the mouth, pharynx or esophagus.
- Globus pharyngeus — a sensation of a foreign body in the neck, sometimes relieved by swallowing.
- Transfer dysphagia — related to nasal regurgitation or pulmonary aspiration, and mostly due to oropharyngeal dysphagia.
- Phagophobia — fear of swallowing, either due to psychotic conditions or anticipatory anxiety about the dysphagia.
A normal swallow needs a bolus of the right size and consistency, an open lumen, effective peristalsis and timely relaxation of the sphincters, so dysphagia appears when one of these fails.
Where to start
- Swallowing physiology and dysphagia pathophysiology — how a normal swallow works, and how structural and propulsive abnormalities produce dysphagia.
- Oropharyngeal and esophageal dysphagia — how dysphagia at the two levels differs in presentation and what causes each.
- Approach to the patient with dysphagia — the history, and the alarm features, that narrow the cause.
- Investigating dysphagia — the tests used at each level, and when to choose them.
- Management of dysphagia — how the cause is treated, and how aspiration and malnutrition are prevented.