DYSPHAGIA

DR.RACHAKONDA RAJKUMAR
M.B.B.S.,M.D(GENERAL MEDICINE).
 DYSPHAGIA
• INTRODUCTION:
• DYSPHAGIA
–  Aphagia
– Odynophagia
–  Globus pharyngeus
– Transfer dysphagia
– Phagophobia.
• PHYSIOLOGY OF SWALLOWING:
– voluntary (oral) phase
–  transfer phase
• primary peristalsis 
• deglutitive inhibition
• secondary peristalsis(GERD)
• Tertiary esophageal contractions
– Medulla oblongata
– cranial nerves involved in swallowing:
– Trigeminal (V)
– Facial (VII)
– Glossopharyngeal(IX)
– Vagus(X)
– Hypoglossal nerve(XII)
Sagittal and diagrammatic views of the musculature involved in enacting oropharyngeal swallowing. Note the dominance of the tongue in the sagittal view and the
intimate relationship between the entrance to the larynx (airway) and the esophagus. In the resting configuration illustrated, the esophageal inlet is closed. This is
transiently reconfigured such that the esophageal inlet is open and the laryngeal inlet closed during swallowing. (Adapted from PJ Kahrilas, in DW Gelfand and JE Richter
[eds]: Dysphagia: Diagnosis and Treatment. New York: Igaku-Shoin Medical Publishers, 1989, pp. 11–28.)

Citation: Chapter 40 Dysphagia, Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, 20e; 2018. Available at:
https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192012726 Accessed: December 05, 2021
Copyright © 2021 McGraw-Hill Education. All rights reserved
• PATHOPHYSIOLOGY OF DYSPHAGIA:
– LOCATION:
• Oral Dysphagia
• Pharyngeal Dysphagia
– greater difficulty managing liquids than solids
• Esophageal Dysphagia.
– Achalasia.

– CIRCUMSTANCES:
• structural dysphagia
– Intermittent ,with solid food.
• propulsive or motor dysphagia.
– Both solids and liquids

– BOLUS+SENSORY INNERVATION+CNS
•
• APPROACH TO THE PATIENT WITH DYSHAGIA:
– HISTORY
• extremely valuable
•  localization
• Circumstances
• other symptoms
• Progression
• Chest pain
• Neoplasia(weeks to months)
• Benign (episodic,years)
• Mucocutaneous disease
• ulceration / immunocompromised.
• PHYSICAL EXAMINATION:
– Oropharyngeal
– r/o bulbar and pseudobulbar
– Thyromegaly
– Missing dentition
–  Skin disease
• DIAGNOSTIC PROCEDURES:
– cardinal symptom of several malignancies
• Intraluminal/extrinsic compression
– guided by the details of the history
– identifiable and treatable disease
• Oral or pharyngeal dysphagia:
• fluoroscopic swallow study
•  Otolaryngoscopic
• neurologic evaluation 
•  Esophageal dysphagia
• upper endoscopy
– esophageal mucosal biopsies
• Esophageal manometry 
–  esophageal motor disorder

•  Barium radiography
• adjunctive;  subtle/complex esophageal strictures
• CT and endoscopic USG.
Approach to the patient with dysphagia. Etiologies in bold print are the most common. ENT, ear, nose, and throat; GERD, gastroesophageal reflux disease.

Citation: Chapter 40 Dysphagia, Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, 20e; 2018. Available at:
https://accessmedicine.mhmedical.com/content.aspx?bookid=2129&sectionid=192012726 Accessed: December 05, 2021
Copyright © 2021 McGraw-Hill Education. All rights reserved
• TREATMENT:
–  Oropharyngeal 
• neurologic disorders
» maneuvers devised to reduce pharyngeal residue and
enhance airway protection.
» altering the consistency of ingested food and liquid
• Severe/persistent; gastrostomy &enteral feeding.
• Surgical intervention.
• Chronic neurologic disorders
» nasogastric tube
»  endoscopically placed gastrostomy.
• Esophageal dysphagia:
– esophageal dilatation
• using bougie or balloon dilators.
•  Cancer and achalasia are often managed surgically.
•  Infectious etiologies; antimicrobial medications
• treatment of the underlying immunosuppressive
state.
• eosinophilic esophagitis has emerged as an
important cause of dysphagia
• elimination of dietary allergens
• administration of swallowed, topically acting glucocorticoids.
THANK YOU