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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.
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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).
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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.
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Prognosis and risk of recurrence
Annual mortality associated with GERD is 0.46 per 100,000 individuals.
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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 Canadian Association of Gastroenterologists (CAG 2018). ...
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Diagnostic investigations

Clinical assessment: as per CAG 2018 guidelines, elicit symptoms and perform a physical examination to identify patients with oropharyngeal dysphagia.
B
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Diagnostic procedures

Upper gastrointestinal endoscopy
As per CAG 2018 guidelines:
Obtain upper gastrointestinal endoscopy as the initial test to maximize diagnostic yield in patients with persistent esophageal dysphagia.
B
Perform esophageal biopsies to detect mucosal pathology in all patients undergoing endoscopy for esophageal dysphagia unless there are clear features of erosive reflux esophagitis.
B

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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