Utilising case history to diagnose Oesophageal Dysphagia

DYSPHAGIA

OROPHARYNGEAL DYSPHAGIA: OESOPHAGEAL DYSPHAGIA:

 Reported level of dysphagia is HIGH  Reported level of dysphagia may be
 May be for liquids or solids HIGH, MID or LOW
 Aspiration symptoms are usually immediate if present  Aspiration symptoms are delayed if
 Regurgitation is usually immediate if present present
 Onset may be sudden or progressive  Symptoms present for solids > liquids
 Voice change may be present  Regurgitation is delayed if present
 Neurological history may be present  Onset is usually slowly progressive
 Voice change not necessarily present
 Neurological history not necessarily
present

NOTE:
Overlap may occur
STRUCTURAL: Eg. Late stage FUNCTIONAL:
(eg. Stenosis, narrowing 2o stricture achalasia, (eg. Motility disorder)
or tumour) severe reflux &  Slowly progressive in nature
 Progressive in nature scleroderma  Dysphagia for solids and liquids
 Dysphagia for solids > liquids  Pain / discomfort often a feature
 Bolus obstruction may occur  Aspiration is a feature of achalasia
 Aspiration is a late feature &
infrequent
EXCEPTION:
Tracheo-
esophageal fistula

BENIGN: MALIGNANT: ACHALASIA & DIFFUSE SPASM:

 Stricture  Primary – SCC or SCLERODERMA:  Evident for solids
 Ring / web adenocarcinoma  Progressive for = liquids
 Caustic injury  Secondary – solids  liquids  Inconsistent
 Extrinsic extrinsic  Consistent presentation
compression compression ( eg. presentation  Pain is a key
(cardiac vs Lung cancer)  Discomfort is feature
mediastinal)  Weight loss is key often a key  Worse for cold
feature feature substances
 Can be rapidly
progressive

Nicola CLAYTON – NSW Dysphagia Interest Group 2016