ASGE Annual GI Advanced Practice Provider Course (Virtual) - Day Two | April 2022-18_Evaluation of Patient with Dysphagia

18_Evaluation of Patient with Dysphagia - Martin Myburgh

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This document is an evaluation of dysphagia, which is the medical term for difficulty swallowing. The objective of this evaluation is to define dysphagia, describe its different types, determine its causes, discuss the workup process, and explore available treatments. It is important to note that the authors have no financial relationships with commercial support to disclose.<br /><br />Dysphagia can be described as painful swallowing, food getting stuck in the esophagus, difficulty swallowing, or swallowed food coming back up. It is not always a medical emergency, but it can become one if a patient cannot successfully swallow solid food, cannot swallow liquids for hydration, or cannot manage their own secretions.<br /><br />There are two main types of dysphagia: oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia refers to dysfunction of bolus transfer, while esophageal dysphagia refers to dysfunction of bolus transit. Before categorizing dysphagia, it is important to exclude mechanical obstruction through patient questioning, endoscopy, and an esophagogram.<br /><br />Mechanical obstruction can be caused by various factors such as foreign body impaction, cricopharyngeal bar, Zenker's diverticulum, esophageal web, esophageal ring, esophageal diverticulum, and esophageal stricture (benign or malignant). On the other hand, dysmotility can be a source of esophageal dysphagia and can be caused by conditions like gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), scleroderma, diffuse esophageal spasm (DES), nutcracker esophagus, achalasia, and pseudoachalasia.<br /><br />The workup of dysphagia involves various diagnostic procedures such as modified barium swallow, esophagogastroduodenoscopy with biopsy, barium esophagogram, esophageal manometry, and impedance planimetry. Treatment options for esophageal obstruction include endoscopic disimpaction, dilation, surgery, diverticulectomy, and antireflux treatment. Treatment of esophageal dysmotility may involve lifestyle modifications, medication, dilation, myotomy, or surgical resection/cancer treatment.<br /><br />In conclusion, dysphagia is characterized by difficulty swallowing and can be caused by mechanical obstruction, dysmotility, or both. The workup of dysphagia involves various diagnostic procedures, and treatment options depend on the underlying cause of the dysphagia.

Keywords

dysphagia

difficulty swallowing

types of dysphagia

causes of dysphagia

workup process

available treatments

oropharyngeal dysphagia

esophageal dysphagia

mechanical obstruction

dysmotility