Dysphagia—difficulty swallowing—can range from mildly inconvenient to life-threatening. This article breaks down its causes, red flags, diagnostic process, and effective treatments.
What is Dysphagia?
- Definition (difficulty with swallowing solids or liquids)
- Impact on eating, nutrition, and quality of life
- Differentiation from odynophagia (painful swallowing)
Key Features of Dysphagia
- Oesophageal vs oropharyngeal dysphagia
- Progressive vs intermittent
- Association with solids, liquids, or both
- Relation to posture, regurgitation, aspiration
Major Categories of Dysphagia Causes
1. Neuromuscular Dysphagia
- Stroke (CVA), MS, MND, Guillain-Barré, polio
- Myasthenia gravis
- Mechanism: nerve or muscle weakness → impaired swallowing coordination
2. Mural Causes
- Achalasia – young adults/elderly, regurgitation, liquids > solids
- Carcinoma of oesophagus – progressive, weight loss
- GORD scarring – reflux, heartburn history
- Scleroderma – associated systemic symptoms
- Chagas disease – in endemic regions
- Diffuse oesophageal spasm – corkscrew oesophagus
3. Intraluminal Causes
- Food bolus – acute, sudden
- Foreign body (common in children) – toys, coins
- Caustic ingestion – strictures (risk of carcinoma)
4. Extraluminal Causes
Compression from:- Mediastinal lymphadenopathy
- Carcinoma of bronchus/trachea
- Left atrial dilatation
- Large pharyngeal pouch
- Tracheo-oesophageal fistula
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Dysphagia by Age Group
Children
- Common: foreign body, caustic ingestion, congenital fistula
Young Adults
- Reflux stricture, achalasia
Elderly
- Esophageal carcinoma
- Reflux and associated strictures
Red Flags in Dysphagia
- Progressive symptoms
- Weight loss
- Low-grade anemia
- Hematemesis
- Nocturnal regurgitation
- Dysphagia to both solids and liquids
Always suspect malignancy in new progressive dysphagia.
Diagnostic Approach
1. Initial Work-up
- History (onset, progression, solids/liquids, regurgitation)
- Physical exam
2. Laboratory Investigations
- Full Blood Count (FBC) → anemia in carcinoma
- Liver Function Tests (LFTs) → underlying hepatic disease
3. Imaging and Procedures
OGD (Endoscopy):
- Visualizes esophagus
- Biopsy of tumors
- Differentiates tumor vs achalasia vs reflux stricture
Video Contrast Swallow (Barium)
- Identifies diverticulum, reflux, fistula
- Good for non-invasive screening
Esophageal Manometry
- Measures peristaltic pressure
- Essential in achalasia and motility disorders
- Rule out extrinsic causes: tumors, lymphadenopathy, atrial dilation
Important Diagnostic Features by Condition
Carcinoma of Esophagus
- Weight loss, anorexia, anemia
- Hematemesis, progressive dysphagia
Achalasia
- Long history, regurgitation, recurrent chest infections
- Liquids more difficult than solids
Reflux Esophagitis / Stricture
- Heartburn, post-meal regurgitation, nocturnal symptoms
Chagas Disease
- South America, autonomic dysfunction
Tracheo-esophageal Fistula
- Cough after swallowing, recurrent infections
- Congenital or secondary to radiation/surgery
Related condition: Haemoptysis Overview
Dysphagia Management and Treatment
Dietary & Lifestyle Adjustments
- Modify texture of food
- Sit upright during meals
- Avoid irritants (alcohol, spicy foods)
Medical Treatments
- PPIs for reflux
- Calcium channel blockers or nitrates for spasm
- Botulinum toxin for achalasia
Endoscopic Interventions
- Balloon dilatation
- Stenting (in cancer)
Surgical Treatments
- Heller myotomy (for achalasia)
- Tumor resection + chemotherapy/radiotherapy
- Removal of foreign body
FAQs About Dysphagia
What are the common causes of dysphagia in the elderly?
Esophageal carcinoma and reflux-related strictures.
Can dysphagia be life-threatening?
Yes, especially if due to malignancy or foreign body aspiration.
What is the best test for diagnosing dysphagia?
Endoscopy is the gold standard; video swallow is useful for functional issues.
How can I tell if my dysphagia is serious?
Red flag symptoms like weight loss, bleeding, or progressive difficulty need urgent evaluation.
Is dysphagia reversible?
Depends on the cause — reflux and achalasia are treatable; cancer needs prompt intervention.
Dysphagia is more than just difficulty swallowing—it could be a sign of serious underlying disease. Identifying the cause early through proper history, imaging, and endoscopy is key to treatment and recovery.
