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.
- Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone.
- CVA is most common cause of oropharyngeal dysphagia
- Barium swallow
- Consider esophageal pH probe, manometry
Adapted from 1
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