Table of contents
Esophageal dysphagia
Background
Overview
Definition
Esophageal dysphagia is characterized by difficulty transporting food down the esophagus due to involvement of the esophageal body and esophagogastric junction.
1
Pathophysiology
Esophageal dysphagia is caused by structural or inflammatory abnormalities (strictures, rings, webs, malignancy, reflux esophagitis, eosinophilic esophagitis) and motility disorders (achalasia, ineffective esophageal motility, esophageal spasm, esophagogastric junction outflow obstruction).
1
Disease course
Clinical manifestations of esophageal dysphagia include difficulty swallowing solids and liquids, intermittent or progressive dysphagia, food bolus impaction, food regurgitation, heartburn, weight loss, anorexia, respiratory distress, hypotension, and atypical chest pain.
2
Prognosis and risk of recurrence
Annual mortality associated with GERD is 0.46 per 100,000 individuals.
3
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of esophageal dysphagia are prepared by our editorial team based on guidelines from the American Gastroenterological Association (AGA 2024), the British Society of Gastroenterology (BSG/BSPGHAN 2022), the American Academy of Family Physicians (AAFP 2021,2020), the European Society of Gastrointestinal Endoscopy (ESGE 2021,2020), the American College of Radiology (ACR 2019), the British ...
Show more
Screening and diagnosis
Indications for screening: as per AAFP 2021 guidelines, screen older patients with chronic illness or recent pneumonia for dysphagia.
B
More topics in this section
Differential diagnosis
Diagnostic investigations
Clinical assessment: as per AAFP 2020 guidelines, ask patients with dysphagia about opioid use and assist in discontinuing or tapering the medication.
B
More topics in this section
Barium esophagram
Esophageal manometry
CT
Diagnostic procedures
Upper gastrointestinal endoscopy: as per AAFP 2021 guidelines, obtain upper gastrointestinal endoscopy to rule out esophageal pathology in patients with apparent oropharyngeal symptoms but a negative evaluation.
B
More topics in this section
Esophageal biopsy
Medical management
PPIs
As per CAG 2018 guidelines:
Provide a diagnostic and therapeutic trial of an oral PPI (given BID) in patients < 50 years of age presenting with esophageal dysphagia and reflux symptoms, in whom there are no alarm features to suggest underlying malignancy (bleeding, odynophagia, weight loss, or vomiting).
B
Obtain further testing if dysphagia does not resolve completely after a 4-week trial of acid suppression therapy in patients with esophageal dysphagia in whom a trial of a PPI was initiated.
B
More topics in this section
Management of esophageal motility disorders