Dysphagia

• Causes of dysphagia:

  • Obstruction arising in the oesophageal wall
  • Disorders of neuromuscular function
  • External compression of the oesophagus
• Obstruction arising in the oesophageal wall:

  • Peptic oesophagitis often associated with hiatus hernia (common)
  • Carcinoma of oesophagus or cardia (common)
  • Candida oesophagitis
  • Pharyngeal pouch
  • Oesophageal web (plummer-vinson syndrome)
• Disorders of neuromuscular function:

  • Achalasia
  • Bulbar or pseudobulbar palsy e.g. motor neurone disease
  • Myasthenia gravis
• External compression of the oesophagus:

  • Lymphadenopathy secondary to bronchial carcinoma
  • Left atrial dilatation secondary to mitral stenosis
• Investigation of dysphagia:

  • Must be regarded seriously and fully investigated - 2WW referral
  • Plain CXR for bronchial carcinoma
  • CXR can reveal an oesophageal fluid level behind the heart resulting from a stricture, hiatus hernia or achalasia
  • High dysphagia - flexible pharyngoscopy with barium swallow
  • Lower dysphagia - OGD
  • Oesophageal manometry and pH monitoring for achalasia