Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.
The terms dysphagia, odynophagia, and globus are defined as follows:
- Dysphagia is a subjective sensation of difficulty or abnormality of swallowing.
- Odynophagia is pain with swallowing.
- Globus sensation is a nonpainful sensation of a lump, tightness, foreign body or retained food bolus in the pharyngeal or cervical area. Globus, on the other hand, is a functional esophageal disorder that is characterized by globus sensation but without an underlying structural abnormality, gastroesophageal reflux disease, or a major esophageal motility disorder.
Some estimates suggest 1 in 25 elder adults in USA have it, otherwise generally unclear due to varying etiology and complications that arise.
Higher incidence in females than males, incidence increases with age.
It is NOT a sign of normal aging in adults and should be evaluated whenever concerns are present.
Acute onset dysphagia is almost always d/t food impaction/foreign body ingestion and should be treated immediately.
Generally divided into oropharyngeal vs. esophageal dysphagia:
(Oropharyngeal Dysphagia - long list, click to open)
- Medication side effects (chemotherapy, neuroleptics, etc).
- Postsurgical muscular or neurogenic.
- Corrosive (pill injury, intentional).
- Mucositis (herpes, cytomegalovirus, Candida, etc).
- Lyme Disease.
- Cushing's syndrome.
- Wilson disease.
- Connective tissue disease (overlap syndrome).
- Myasthenia gravis.
- Myotonic dystrophy.
- Oculopharyngeal dystrophy.
- Paraneoplastic syndromes.
- Brainstem tumors.
- Head trauma.
- Cerebral palsy.
- Guillain-Barré syndrome.
- Huntington disease.
- Multiple sclerosis.
- Postpolio syndrome.
- Tardive dyskinesia.
- Metabolic encephalopathies.
- Amyotrophic lateral sclerosis.
- Parkinson disease.
- Cricopharyngeal bar.
- Zenker's diverticulum.
- Cervical webs.
- Oropharyngeal tumors.
- Osteophytes and skeletal abnormalities.
- Congenital (cleft palate, diverticula, pouches, etc).
(Esophageal Dysphagia - long list, click to open)
- Benign tumors.
- Caustic esophagitis/stricture.
- Peptic stricture.
- Eosinophilic esophagitis.
- Infectious esophagitis.
- Pill esophagitis.
- Postsurgery (laryngeal, esophageal, gastric).
- Radiation esophagitis/stricture.
- Rings and webs.
- Lymphocytic esophagitis.
- Aberrant subclavian artery.
- Cervical osteophytes.
- Enlarged aorta.
- Enlarged left atrium.
- Mediastinal mass (lymphadenopathy, lung cancer, etc).
- Postsurgery (laryngeal, spinal).
- Chagas disease.
- Primary motility disorders.
- Secondary motility disorders.
- Difficulty initiating swallow.
- Cervical region discomfort.
- Swallowing may be accompanied by nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx.
- Oral dysfunction can lead to drooling, food spillage, sialorrhea, piecemeal swallows, and dysarthria.
- Pharyngeal dysfunction can lead to coughing or choking during food consumption, and dysphonia.
- Difficulty in swallowing seconds after it is initiated.
- Difficult/sensation of food passaging from lower esophagus to upper stomach.
Other Signs and Symptoms
- Weight loss.
- Regurgitation of food particles.
- Respiratory symptoms.
- HPI: Need to know: (1) Solids, liquids, or both? (2) Progressive vs. intermittent (3)
- ROS: Odynophagia may indicate an infectious etiology.
- ALL/MEDS/HIITS: (What are HIITS? - Click to expand) Meds: (Ask specifically about potassium chloride, alendronate, ferrous sulfate, quinidine, ascorbic acid, tetracycline, aspirin and NSAIDs)
- PMH/FAMHx/OBGYN: FamHx GI cancer
- SOCHx: Smoking/EtOH/Recreational drugs
- Initial test is barium esophagram.
- Esophageal manometry.
- Swallow study.
See pathogenesis section.
- General: Diet changes, swallowing maneuvers, piecemeal ingestion.
- Treat underlying cause, depending on level of neurologic dysfunction, may need enteral feeds.
- Myotomy if achalasia/inability of pharynx to relax. Similarly botulinum toxin injection