Dysphagia history and symptoms: Difference between revisions
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==Symptoms of Oropharyngeal Dysphagia== | ==Symptoms of Oropharyngeal Dysphagia== | ||
The evaluation and management of dysphagia is a multidimensional task and often requires a multidisciplinary approach. Important initial steps include confirming the presence of a swallowing dysfunction; defining its anatomic level (oropharyngeal vs esophageal), its mechanism (motor vs mechanical), and underlying specific etiology; and ascertaining the integrity of oropharyngeal swallow and the degree of risk or presence of silent or overt aspiration. Subsequent assessment must determine the patients abilities and impairments and the degree to which these impairments can be improved. A careful history remains the cornerstone of any dysphagia evaluation, and a thorough review of symptoms can differentiate esophageal from oropharyngeal dysphagia24 and predict the specific cause of dysphagia with an accuracy of approximately 80% confirmed by specific testing. How a patient describes his or her difficulty and its timing, associated symptoms, and other characterizations may specifically denote the anatomic level of swallowing dysfunction | |||
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Revision as of 17:27, 1 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
The hallmark of dysphagia is difficulty in swallowing. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Symptoms of Oropharyngeal Dysphagia
The evaluation and management of dysphagia is a multidimensional task and often requires a multidisciplinary approach. Important initial steps include confirming the presence of a swallowing dysfunction; defining its anatomic level (oropharyngeal vs esophageal), its mechanism (motor vs mechanical), and underlying specific etiology; and ascertaining the integrity of oropharyngeal swallow and the degree of risk or presence of silent or overt aspiration. Subsequent assessment must determine the patients abilities and impairments and the degree to which these impairments can be improved. A careful history remains the cornerstone of any dysphagia evaluation, and a thorough review of symptoms can differentiate esophageal from oropharyngeal dysphagia24 and predict the specific cause of dysphagia with an accuracy of approximately 80% confirmed by specific testing. How a patient describes his or her difficulty and its timing, associated symptoms, and other characterizations may specifically denote the anatomic level of swallowing dysfunction
| Symptoms of oropharyngeal dysphagia | Associated symptoms |
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Symtoms of Esophageal Dysphagia
| Symtoms of esophageal dysphagia | |
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Symptoms in Adults may Include:
- Hesitation or inability to swallow
- Difficult or painful swallowing
- Constant feeling of a lump in the throat
- Inability to recognize food and taste it
- Food sticking in the throat
- Food coming up (regurgitation) through the throat or nose
- Chest pain or discomfort when swallowing
- Difficulty swallowing solid foods
- Frequent, repetitive swallowing
- Excessive throat clearing
- "Gurgly" sounding voice after eating
- Hoarse voice or recurrent sore throat
- Coughing during or after swallowing
- Necessity to "wash down" solid foods
- Recurrent episodes of pneumonia
- Frequent heartburn
- Food or stomach acid backing up into your throat (acid reflux)
- Unexpected weight loss
When asked where the food is getting stuck patients will often point to the cervical (neck) region as the site of the obstruction. However, this may be misleading due to patients' inaccurate sensation of the site of obstruction (with obstructions / dysmotilities lower in the esophagus being common).
In Infants and Children, Symptoms may Include:
- Low interest in feeding or meals
- Tension in the body while feeding
- Refusal to eat foods that have certain textures
- Lengthy feeding or eating times (30 minutes or longer)
- Food or liquid leaking from the mouth
- Coughing or gagging when eating or nursing
- Spitting up or vomiting during feeding or meals
- Strained breathing while eating and drinking
- Poor weight gain or growth
Symptoms of Esophageal Dysphagia
Patients usually experience food getting stuck several seconds after swallowing, and will point to the suprasternal notch or behind the sternum as the site of obstruction. If there is dysphagia to both solids and liquids, then it is most likely a motility problem. If there is dysphagia initially to solids but progresses to also involve liquids, then it is most likely a mechanical obstruction. Once a distinction has been made between a motility problem and a mechanical obstruction, it is important to note whether the dysphagia is intermittent or progressive. An intermittent motility dysphagia likely can be diffuse esophageal spasm (DES) or nonspecific esophageal motility disorder (NEMD). Progressive motility dysphagia disorders include scleroderma or achalasia with chronic heartburn, regurgitation, respiratory problems, or weight loss. Intermittent mechanical dysphagia is likely to be an esophageal ring. Progressive mechanical dysphagia is most likely due to peptic stricture or esophageal cancer.