Definition: Difficulty in swallowing.
• The act of swallowing begins with propulsion of food to posterior pharynx
• The soft palate elevates to close the nasopharynx.
• The epiglottis close the larynx
• The upper esophageal sphincter relaxes
• The contraction of pharyngeal constrictors propels the bolus into the esophagus
• The relaxation of the LES during swallowing is under the control of vagus (presynaptic
transmission by acetyl choline and post synaptic by NO and VIP) and other hormones.
A. Mechanical causes
I. Painful diseases of the mouth & pharynx: Stomatitis, pharyngitis, tonsillitis &
retmpharyngeal abscess.
II. Intrinsic disease of the oesophagus:
• Congenital anomalies as atresia.
• Gastro oesophageal reflux disease (GORD).
• Stricture due to corrosive oesophagitis.
• Tumors: Cancer oesophagus, sarcoma, lymphoma
• Plummer-Vinson syndrome.
• Scleroderma.
III. Compression of the esophagus.
1. Cervical spondylosis
2. Thyroid enlargement
3. Left atrial enlargement
4. Zenker's diverticulum
5. Retropharyngeal abcess
6. Posterior mediastinal masses
B. Motor causes:
1. Neurological diseases
• Bulbar & pseudo-bulbar palsy.
• Neuritis & myasthenia gravis
• Polymyositis.
2. Functional: Achalasia & esophageal spasm.
Commonest causes of dysphagia: Cancer, achalasia, post-corrosive .
History:
1. Age: cancer in old age, post corrosive in children
2. Type of food: only to solids in mechanical causes, while to both solids and fluids in motor
dysphagia
3. Duration and course:
Short: inflammatory causes
Intermittent: Functional disorders
Progressive: cancer
4. Associated symptoms:
Severe loss of weight in cancer
Manifestations of thyroid dysfunction in cases with goiter
Nasal regurgitation in neurological causes
Physical examination:
1. Neck: for thyroid enlargement
2. Features of scleroderma
1. Endoscopy
2. Barium swallow
3. Esophageal manometry
Physiology:
• The act of swallowing begins with propulsion of food to posterior pharynx
• The soft palate elevates to close the nasopharynx.
• The epiglottis close the larynx
• The upper esophageal sphincter relaxes
• The contraction of pharyngeal constrictors propels the bolus into the esophagus
• The relaxation of the LES during swallowing is under the control of vagus (presynaptic
transmission by acetyl choline and post synaptic by NO and VIP) and other hormones.
Etiology:
A. Mechanical causes
I. Painful diseases of the mouth & pharynx: Stomatitis, pharyngitis, tonsillitis &
retmpharyngeal abscess.
II. Intrinsic disease of the oesophagus:
• Congenital anomalies as atresia.
• Gastro oesophageal reflux disease (GORD).
• Stricture due to corrosive oesophagitis.
• Tumors: Cancer oesophagus, sarcoma, lymphoma
• Plummer-Vinson syndrome.
• Scleroderma.
III. Compression of the esophagus.
1. Cervical spondylosis
2. Thyroid enlargement
3. Left atrial enlargement
4. Zenker's diverticulum
5. Retropharyngeal abcess
6. Posterior mediastinal masses
B. Motor causes:
1. Neurological diseases
• Bulbar & pseudo-bulbar palsy.
• Neuritis & myasthenia gravis
• Polymyositis.
2. Functional: Achalasia & esophageal spasm.
Commonest causes of dysphagia: Cancer, achalasia, post-corrosive .
Approach to diagnosis of dysphagia:
History:
1. Age: cancer in old age, post corrosive in children
2. Type of food: only to solids in mechanical causes, while to both solids and fluids in motor
dysphagia
3. Duration and course:
Short: inflammatory causes
Intermittent: Functional disorders
Progressive: cancer
4. Associated symptoms:
Severe loss of weight in cancer
Manifestations of thyroid dysfunction in cases with goiter
Nasal regurgitation in neurological causes
Physical examination:
1. Neck: for thyroid enlargement
2. Features of scleroderma
Investigations:
1. Endoscopy
2. Barium swallow
3. Esophageal manometry