Skip to main content
SpringerLink
Log in

Dysphagia: How to Recognize and Narrow the Differential

  • Chapter
  • First Online:
Book cover Evaluation and Management of Dysphagia

  • 1152 Accesses

Abstract

Dysphagia is a common symptom that results in difficulty with one of life’s essential functions, eating. Causes of dysphagia are extremely variable including rare neurologic diseases, esophageal motility disorders, as well as malignancy. Narrowing down the differential for dysphagia first begins with separating the symptoms into either oropharyngeal dysphagia or esophageal dysphagia and mechanical, motility, or sensory causes. Beyond this, there are certain details in the patient’s clinical and medical history that may help lead to the underlying diagnosis. These key points have been studied and published as detailed in this chapter. Additionally, patient-reported outcome measures are instrumental in helping assess disease response to treatment. These have been well studied in esophageal cancer, mechanical and neuromyogenic oropharyngeal dysphagia, achalasia, and eosinophilic esophagitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. DeVault K. Symptoms of esophageal disease. In: Feldman M, Friedman L, Brandt LS, editors. Fortran’s gastrointestinal and liver disease. 9th ed. Philadelphia: Elsevier Inc; 2010.

    Google Scholar 

  2. Cho SY, Choung RS, Saito YA, Schleck CD, Zinsmeister AR, Locke GR 3rd, Talley NJ. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212–9.

    Article  CAS  Google Scholar 

  3. Malagelada JR, Bazzoli F, Boeckxstaens G, De Looze D, Fried M, Kahrilas P, Lindberg G, Malfertheiner P, Salis G, Sharma P, Sifrim D, Vakil N, Le Mair A. World gastroenterology organisation global guidelines: dysphagia—global guidelines and cascades update September 2014. J Clin Gastroenterol. 2015;49(5):370–8.

    Article  Google Scholar 

  4. Abdel Jalil AA, Katzka DA, Castell DO. Approach to the patient with dysphagia. Am J Med. 2015;128(10):1138.e17–23.

    Article  Google Scholar 

  5. Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: thinking outside the box. World J Gastroenterol. 2017;23(38):6942–51.

    Article  Google Scholar 

  6. Cook IJ, Kahrilas PJ. AGA technical review on management of oropharyngeal dysphagia. Gastroenterology. 1999;116(2):455–78.

    Article  CAS  Google Scholar 

  7. Chen CL, Orr WC. Comparison of esophageal motility in patients with solid dysphagia and mixed dysphagia. Dysphagia. 2005;20(4):261–5.

    Article  Google Scholar 

  8. Newberry C, Vajravelu RK, Pickett-Blakely O, Falk G, Yang YX, Lynch KL. Achalasia patients are at nutritional risk regardless of presenting weight category. Dig Dis Sci. 2018;63(5):1243–9.

    Article  Google Scholar 

  9. Furuta GT, Katzka DA. Eosinophilic esophagitis. N Engl J Med. 2015;373(17):1640–8.

    Article  CAS  Google Scholar 

  10. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci. 1995;40(10):2192–6.

    Article  CAS  Google Scholar 

  11. Smith DF, Ott DJ, Gelfand DW, Chen MY. Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus. AJR Am J Roentgenol. 1998;171(5):1361–5.

    Article  CAS  Google Scholar 

  12. Roeder BE, Murray JA, Dierkhising RA. Patient localization of esophageal dysphagia. Dig Dis Sci. 2004;49(4):697–701.

    Article  Google Scholar 

  13. Zerbib F, Omari T. Oesophageal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2015;12(6):322–31.

    Article  Google Scholar 

  14. Antonik S, Shaker R. Disorders causing oropharyngeal dysphagia. In: Richter J, Castell D, editors. The esophagus. 5th ed. Oxford: Blackwell Publishing Ltd. p. 2012.

    Chapter  Google Scholar 

  15. Ravi K, Murray JA, Geno DM, Katzka DA. Achalasia and chronic opiate use: innocent bystanders or associated conditions? Dis Esophagus. 2016;29(1):15–21.

    Article  CAS  Google Scholar 

  16. Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017;15(9):1338–49.

    Article  CAS  Google Scholar 

  17. Ahmed S, Berzon RA, Revicki DA, et al. The use of patient-reported outcomes (PRO) within comparative effectiveness research: implications for clinical practice and health care policy. Med Care. 2012;50:1060–70.

    Article  Google Scholar 

  18. Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF, Francis DO. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus. 2017;30(5):1–23.

    Article  CAS  Google Scholar 

  19. Spiegel BM, Hays RD, Bolus R, Melmed GY, Chang L, Whitman C, Khanna PP, Paz SH, Hays T, Reise S, Khanna D. Development of the NIH patient-reported outcomes measurement information system (PROMIS) gastrointestinal symptom scales. Am J Gastroenterol. 2014;109(11):1804–14.

    Article  Google Scholar 

  20. Grudell AB, Alexander JA, Enders FB, Pacifico R, Fredericksen M, Wise JL, Locke GR 3rd, Arora A, Zais T, Talley NJ, Romero Y. Validation of the Mayo dysphagia questionnaire. Dis Esophagus. 2007;20(3):202–5.

    Article  CAS  Google Scholar 

  21. Wallace KL, Middleton S, Cook IJ. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology. 2000;118(4):678–87.

    Article  CAS  Google Scholar 

  22. Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–6.

    CAS  PubMed  Google Scholar 

  23. McHorney CA, Robbins J, Lomax K, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17:97–114.

    Article  Google Scholar 

  24. Darling G, Eton DT, Sulman J, Casson AG, Celia D. Validation of the functional assessment of cancer therapy esophageal cancer subscale. Cancer. 2006;107:854–63.

    Article  Google Scholar 

  25. Lagergren P, Fayers P, Conroy T, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQOG25, to assess health-related quality of life in patients with cancer of the oesophagus, the oesophago-gastric junction and the stomach. Eur J Cancer. 2007;43:2066–73.

    Article  Google Scholar 

  26. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psychometric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer. 2003;39:1384–94.

    Article  CAS  Google Scholar 

  27. Urbach DR, Tomlinson GA, Harnish JL, Martino R, Diamant NE. A measure of disease-specific health-related quality of life for achalasia. Am J Gastroenterol. 2005;100:1668–76.

    Article  Google Scholar 

  28. Schoepfer AM, Straumann A, Panczak R, Coslovsky M, Kuehni CE, Maurer E, Haas NA, Romero Y, Hirano I, Alexander JA, Gonsalves N, Furuta GT, Dellon ES, Leung J, Collins MH, Bussmann C, Netzer P, Gupta SK, Aceves SS, Chehade M, Moawad FJ, Enders FT, Yost KJ, Taft TH, Kern E, Zwahlen M, Safroneeva E, International Eosinophilic Esophagitis Activity Index Study Group. Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis. Gastroenterology. 2014;147(6):1255–66.e21.

    Article  Google Scholar 

  29. Dellon ES, Irani AM, Hill MR, Hirano I. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther. 2013;38:634–42.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Esophageal Physiology Laboratory, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Kristle L. Lynch

  2. The Mayo Clinic, Rochester, MN, USA

    David A. Katzka

Authors
  1. Kristle L. Lynch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David A. Katzka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Katzka .

Editor information

Editors and Affiliations

  1. Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA

    Dhyanesh A. Patel

  2. Center for Esophageal Diseases, University of Chicago Medical Center, Chicago, IL, USA

    Robert T. Kavitt

  3. Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, Nashville, TN, USA

    Michael F. Vaezi

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lynch, K.L., Katzka, D.A. (2020). Dysphagia: How to Recognize and Narrow the Differential. In: Patel, D., Kavitt, R., Vaezi, M. (eds) Evaluation and Management of Dysphagia . Springer, Cham. https://doi.org/10.1007/978-3-030-26554-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26554-0_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26553-3

  • Online ISBN: 978-3-030-26554-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation