DysphagiaDyphagia 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


Adapted from 1
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1.
Spieker M. Evaluating dysphagia. Am Fam Physician. 2000;61(12):3639-3648. [PubMed]
Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD

@M_Lin

Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at https://t.co/50EapJORCa Bio: https://t.co/7v7cgJqNEn
Michelle Lin, MD