Paucis Verbis card: Dysphagia

Dyphagia is a disorder of swallowing. It actually occurs in up to 10% of adults older than 50 years old. How can you determine the most likely causes for dysphagia? The secret is to obtain a thorough history and using the algorithm below, which I find really helpful from a review article in American Family Physician.

How do you read the figure?

• Determine first if patient has oropharyngeal vs esophageal dysphagia. 
• Determine if mechanical (problem is solid foods only) vs neuromuscular (problem with liquids and solids)is more likely.

Tip

• Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone.
• CVA is most common cause of oropharyngeal dysphagia

Workup

• Endoscopy
• Barium swallow
• Consider esophageal pH probe, manometry