Dysphagia / Odynophagia

Learning objectives:
Review Differential for Oropharyngeal vs Esophageal dysphagia
Discuss the diagnostic w/u of dysphagia

Definitions:
Dysphagia- sticking sensation or obstruction on swallowing
Odynophagia- pain on swallowing
These are often used incorrectly

I. Differential for Oropharyngeal Dysphagia:
A. Mechanical= webs, stricture, mass, infection, abscess, congenital defect ie) cleft palate, extrinsic compression (node, goiter)

B. Motor= neuro and muscular
CVA, Cerebral Palsy, MS with bulbar nerve manifestations, ALS, MG, Myositis ( DM, polymyositis)

**Many of these processes can also be seen in the Esophagus

II. Differential for Esophageal Dysphagia:
A. Mechanical= Congenital defects (fistulas), Infection (candidiasis), Webs, Schiatski's rings, stricture, Tumor, Extrinsic Compression

B. Motor= neuro and muscular
neuropathy (DM), Scleroderma, Diffuse Esophageal spasm, Achalasia primary or secondary (ie chagas)
Pseudoachalasia due to carcinoma

Recommended Studies:
Based on history and review of systems, the most likely etiology should be pursued.
Oropharyngeal Mechanical Dysphagia- direct laryngoscopy
Oropharyngeal Motor dysphagia- Videofluoroscopy
Esophageal Mechanical Dysphagia- Barium Swallow, EGD
Esophageal Motor Dysphagia-barium swallow, EGD, esophageal motility study, +/-manometry
See attached Table Approach to Dysphagia(Harrison's) for details

(Ellen Eaton MD, 4/7/11)