Dysphagia

Etiology

Esophageal dysphagia

• Mechanical obstruction (solids worse than liquids)

1. Esophageal web, ring (eg, Schatzki's), or diverticulum (intermittent dysphagia, not progressive)
2. Peptic stricture (chronic heartburn, progressive dysphagia)
3. Esophageal cancer (progressive dysphagia, age >50)

• Motility disorder (solids and liquids)

1. Achalasia (progressive dysphagia)
2. Diffuse esophageal spasm (intermittent, not progressive)
3. Scleroderma (chronic heartburn)

Oropharyngeal dysphagia

• Neurologic disorders

1. Brainstem stroke, mass lesion
2. Amyotrophic lateral sclerosis, multiple sclerosis, pseudobulbar palsy, postpolio syndrome, Guillain-Barré syndrome
3. Parkinson's disease, Huntington's disease, dementia
4. Tardive dyskinesia

• Muscular and rheumatologic disorders

1. Myopathy, polymyositis
2. Oculopharyngeal dystrophy
3. Sjögren's syndrome

• Metabolic disorders

1. Thyrotoxicosis, amyloidosis, Cushing's disease, Wilson's disease
2. Drugs: anticholinergics, phenothiazines

• Infectious disease

1. Polio, diphtheria, botulism, Lyme disease, syphilis, mucositis (Candida, herpes)

• Structural disorders

1. Zenker's diverticulum
2. Cervical osteophytes, cricopharyngeal bar, proximal esophageal webs
3. Oropharyngeal tumors
4. Postsurgical or radiation changes
5. Pill-induced injury

• Motility disorders

1. Upper esophageal sphincter dysfunction

See related DDx

• Odynophagia
• Heartburn
• Epigastric pain (dyspepsia, upper abdominal pain)
• Esophagitis