Topic 1.1 Dysphagia

More likely to see this in clinic. I have never actually clerked in a patient with dysphagia as a sole symptom.
In simple terms, dysphagia is defined as difficulty in swallowing.  The list of causes are long. A good way to remember them is to divide causes into:


 Inside the lumen

• foreign body
• oesophagitis
• infection - candidiasis

In the wall

• benign stricture
• malignant stricture
• achalasia
• oesophageal spasm 
• oesophageal Web - Plummer Vinson syndrome (middle aged females with Fe def anemia)
• scleroderma
• presbyoesophagus - associated with old age

Outside the wall

• pharangeal pouch
• rolling hiatus hernia
• tumour
• retrosternal goitre
• vascular structures - thoracic AA

Systemic causes

• MG
• MS
• PD
• psuedobulbar palsy

Ok so its going to be hard to remember all of these, but if we just think about in terms of structure then it will be a lot easier.

In very very simple terms, the oesophagus is the food pipe, anything that blocks this pipe or stops it from it from contracting will cause dysphagia - which is difficulty in swallowing. The blockage can be in the lumen - forigen body, inflammation or infection; it can be in the wall of the pipe - stricture, achalesia, oesophageal web, scleroderma and age related changes; it can be outside the pipe pressing in on it - pharangeal pouch, large thyroid, HH, tumour or aneurysm. Systemic causes are listed above.

How to investigate dysphagia?

Coming soon...

Anatomy of the oesophagus will be covered in topic 1.2