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Diagnostic evaluation of dysphagia

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 393–403 (2008)Cite this article

Abstract

Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

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Figure 1: Algorithm used by the author to determine the likely anatomical location of the problem.
Figure 2: Algorithm used by the author to differentiate between esophageal disorders that cause dysphagia.
Figure 3: Findings from a patient with idiopathic achalasia.
Figure 4: Findings from a 28-year-old male with a multiringed esophagus due to eosinophilic esophagitis.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Author notes

  1. Gastroenterology Department, St George Hospital, Gray Street, Kogarah, NSW 2217, Australia i.cook@unsw.edu.au

Authors and Affiliations

  1. IJ Cook is a Professor of Medicine (Conjoint) at the University of New South Wales, and Director of Gastroenterology at The St George Hospital, Sydney, NSW, Australia.,

    Ian J Cook

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Cook, I. Diagnostic evaluation of dysphagia. Nat Rev Gastroenterol Hepatol 5, 393–403 (2008). https://doi.org/10.1038/ncpgasthep1153

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