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

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Reference 
Spieker MR. Evaluating dysphagia. American Family Physician, 2000, 61(12), 3639-48. Read the review article online.