Today in 5-minute refresher lectures I will be discussing dysphagia. These lectures are setup to give busy GPs a general overview and some “pearls of wisdom”. Please always consult your local guidelines for patient management and seek expert advice if unsure.
VIDEO WILL BE ADDED SOON
Dysphagia is a “red flag” symptom, should be taken seriously and trigger prompt investigations.
Difficulty swallowing, or dysphagia is often confused with odynophagia which is painful swallowing. Odynophagia is a much more benign condition caused by inflammation in the oesophagus. The most common causes for oesophagitis are reflux, infections like candidiasis and drugs like NSAIDs or bisphosphonates. First line treatment for odynophagia is high dose PPI and stopping any aggravating medications.
Globus sensation is a functional oesophageal disorder in which patients feel a lump or irritation in their throat that is not due to any structural disorder, motility disorder or reflux.
History is extremely important to determine the cause of dysphagia. Swallowing involves a complex orchestration of different muscle contraction and relaxation. Dysphagia can broadly be divided into:
1: oropharyngeal dysphagia: Patients have difficulty initiating swallow, liquids are worse and may cough when swallowing, Causes include strokes, but also many other neurological conditions such as multiple sclerosis.
2a: Structural oesophageal dysphagia: Problems predominantly with eating solids or meats. Causes included obstruction by cancer, benign strictures, diverticula or in young people an allergic condition called eosinophilic oesophagitis.
2b: neuromuscular oesophageal dysphagia:
3: oesophageal neuromuscular
If the patient has a food bolus obstruction this is a clinical emergency that can lead to perforation if patient does not have endoscopy within 24 hours. There patients therefore should be referred to the emergency department for acute assessment. Trials of different muscle relaxants for food bolus have not shown any affect, therefore patients should go straight to endoscopy.