Dysphagia


- Difficulty Swallowing
- Weight Loss
#1 Test = Barium Study
 
DDx
Diagnosis Differentiating Signs/Symptoms Differentiating Tests
Esphageal Dysphagia
- Mechanical Obstruction (Solid worse than Liquids)
Schatzki's Ring (esohpageal web, ring) intermittent DxL barrium study,
Tx: Pnematic dilation
Peptic Stricture    
Esophageal cancer    
- Motility Disorder
Achalasia LES tone on manometry  
Diffuse esophageal spasm    
Scleroderma    
Oropharyngeal dysphagia
- Neurologic disorder
Brainstem stroke, mass lesion    
Amyotrophic lateral sclerosos    
Multiple sclerosis    
Pseudobulbar palsy    
Postpolio syndrome    
Guillian-Barre syndrome    
Parkinsons disease    
Huntingtons disease    
Dementia    
Tardive dyskinesia    
- Muscular & Rheumatologic Disorder
Myopathy    
Polymyositis    
Oculopharyngreal dystrophy    
Sjogren's syndrome    
- Metabolic disorder
Thyrotoxicosis    
Amyloidosis    
Cushing's disease    
Wilson's disease    
Drugs: anticholinergics, phenothiazines    
- Structural Disorders
Zenker's diverticulum    
Cervical osteophytes    
Cricopharyngeal bar    
Proximal esophageal webs    
Oropharyngeal tumor    
Postsurgical or radiation changes    
Hiatal Hernia    
Pill-induced injury    
- Infectious diseasae
Polio    
Diphtheria    
Botulism    
Lyme disease    
Syphilis    
Mucositis (candida, herpes)    
- Motility disorders
Upper esophageal sphincer dysfunction    
     


 

Manometry
or Absent peristaltic wave LES tone Achalasia
LES tone Scleroderma
Normal peristaltic wave LES tone GERD
Periodic, High-amplitude, non-paristaltic wave Diffuse Esophageal Spasm