ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day Two) | March 2026-Dysphagia: Diagnosis and Management

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The document outlines a practical approach to evaluating dysphagia (difficulty swallowing) and distinguishing it from related esophageal symptoms. Common symptoms include GERD (heartburn/regurgitation), dysphagia (food sticking), odynophagia (pain with swallowing), globus (lump sensation), and water brash (excess salivation from reflux). Dysphagia is categorized into structural (mechanical obstruction), functional/dysmotility, combined causes, and sensory/behavioral etiologies.<br /><br />Structural causes include webs, diverticula, cervical osteophytes, strictures (malignant, peptic, radiation, caustic, anastomotic), Schatzki ring, and vascular compression (dysphagia lusoria), as well as inflammatory conditions such as reflux esophagitis, eosinophilic esophagitis, pill injury, infection, lichen planus, and pemphigoid. Dysmotility causes include neuromuscular disorders (e.g., stroke, myasthenia), achalasia, hypercontractile (“jackhammer”) esophagus, EGJ outflow obstruction, opioid-induced dysmotility, scleroderma, and pseudoachalasia. Sensory/behavioral causes include post-traumatic swallowing fear/hypersensitivity and rumination.<br /><br />History is emphasized: onset and progression, frequency, duration, food consistency triggers, localization, compensatory behaviors (“IMPACT”: fluids with meals, modifying foods, prolonged meals, avoiding textures, excessive chewing, avoiding pills), and nutritional risk. Structural dysphagia typically affects solids/pills and is episodic; dysmotility often affects both solids and liquids, is more consistent, and features regurgitation.<br /><br />Evaluation tools include barium studies (including timed barium swallow), endoscopy with biopsy (and possible empiric dilation), manometry, and EndoFLIP. The recommended workup first excludes mechanical obstruction (endoscopy and/or esophagram); if absent, evaluate for dysmotility with manometry/functional testing.<br /><br />A case illustrates progressive solid/liquid dysphagia with regurgitation leading to esophagram/EGD findings suggestive of achalasia; high-resolution manometry confirms type II achalasia. Achalasia pathophysiology, clinical features, subtype classification, treatment options (Botox, pneumatic dilation, Heller myotomy, POEM), and follow-up strategies are summarized.

Asset Subtitle

Sarel Myburgh, APRN, CNP, MS, and John A. Martin, MD, FASGE

Keywords

dysphagia evaluation

esophageal symptoms differentiation

structural (mechanical) dysphagia

esophageal dysmotility

achalasia type II

high-resolution manometry

barium esophagram timed barium swallow

endoscopy with biopsy dilation

eosinophilic esophagitis

POEM Heller myotomy pneumatic dilation Botox