Difficulty in swallowing associated with pharyngeal or oesophegeal disease

Causes can be neurological, muscular, structural

Differential diagnosis:

• Benign causes:
  • Gastro-oesophageal reflux
  • Oesophageal web
• Malignant strictures
• Extrinsic compression:
  • Aortic arch aneurysm
  • Lymphadenopathy/mediastinal masses (lymphoma, lung cancer)
  • Cervical spondylosis
• Motility disorders:
  • Scleroderma (systemic sclerosis)
  • Achalasia
• Neurological causes:
  • Myesthenia gravis
  • Bulbar palsy

Conditions causing Dysphagia

• Most common lesions in the oesophegus are inflammatory strictures from reflux or tumours, a long history of heartburn is usually associated with an inflammatory stricture
• In Westernised countries, eosinophilic oesophagitis is thought to affect between 40 and 55 per 100,000 population - similar to the numbers affected by Crohn's disease
• Idiopathic achalasia presents with dysphagia for solids and also regurgitation of a bland-tasting material that has never entered the stomach. It occurs in 1-2/100,000, most commonly seen in mid-adult life, and is caused by impaired neural control of the distal oesophagus
• Impairment of oropharyngeal swallowing function and abnormal laryngeal findings have been noted in patients with severe COVID-19 treated in intensive care units

Causes of dysphagia - by classification

PC