General Approach to Patients presenting with Dysphagia

Difficulty in initiating a swallow, misdirectional food causing coughing, choking, or nasal regurgitation

YES

(+ Localized to chest or throat)

Oropharyngeal dysphagia

Neuromuscular findings

Oropharyngeal motor dysphagia

Oropharyngeal mechanical dysphagia

NOYES

Fauci et al:17th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

Mental Status ENT Evaluation

Oropharyngeal motor dysphagia

Oropharyngeal mechanical dysphagia

NOYES

IMPAIRED NORMAL

Videofluoroscopic swallowing study

Oral phase abnormalities Pharyngeal phase abnormalities

Fauci et al:17th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

Difficulty in initiating a swallow, misdirectional food causing coughing, choking, or nasal regurgitation

NO

(+ Localized to chest or throat)

Esophageal dysphagia

Dysphagia to solids or liquids

SOLIDS AND LIQUIDS SOLIDS ONLY

Fauci et al:17th Ed. Harrison’s Principles of Internal Medicine.p.240,2008

SOLIDS AND LIQUIDS

Esophagial Motor dysphagia

•Barium swallow•Esophageal motility•esophagoscopy

+ Prominent heartburn

Scleroderma Achalasia

NOYES

SOLIDS ONLY

Esophageal mechanical dysphagia

•Esophagoscopy•Barium swallow

Episodic or progressive

EPISODIC PROGRESSIVE

Lower esophageal ring

Carcinoma

Fauci et al:17th Ed. Harrison’s Principles of Internal Medicine.p.240,2008