Dysphagia history and symptoms

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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 most important factor in the evaluation of any dysphagia is a detailed history, and a thorough review of symptoms that can differentiate esophageal from oropharyngeal dysphagia and help predict the specific etiology. How a patient describes the symptoms and their timing, associated historical features, and other characterizations may specifically denote the anatomic level of swallowing dysfunction.

Symptoms of Oropharyngeal Dysphagia

Evaluation and management of dysphagia is a multidimensional task and requires a multidisciplinary approach. Initial steps include the following:[1][2][3][4][5][6]

  • Confirming the presence of a swallowing dysfunction.
  • Defining its anatomic level (oropharyngeal vs esophageal) [7]
  • Mechanism (motor vs mechanical)
  • 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.
Symptoms of oropharyngeal dysphagia Associated symptoms
  • Difficulty in initiating a swallow
  • Nasopharyngeal regurgitation following the swallow
  • Oral dysfunction can lead to dysarthria, food spillage, piecemeal swallows and drooling.
  • Swallowing may be accompanied by a sensation of residual food in the pharynx, nasopharyngeal regurgitation, and aspiration.
  • Pharyngeal dysfunction leads to dysphonia, choking or coughing during food consumption.
  • Frequent, repetitive swallowing
  • Excessive throat clearing
  • "Gurgly" sounding voice after eating
  • Food or stomach acid backing up into your throat
  • Weight loss
  • Anemia
  • Heartburn
  • Regurgitation of food particles

Symtoms of Esophageal Dysphagia

Symtoms of esophageal dysphagia
  • Sensation of food obstruction in the passage from the upper esophagus to the stomach
  • Difficulty swallowing after sometime of initiating a swallow
  • Patient points to the suprasternal notch or behind the sternum as the site of obstruction

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

References

  1. Jamieson J, Hinder RA, DeMeester TR, Litchfield D, Barlow A, Bailey RT (1989). "Analysis of thirty-two patients with Schatzki's ring". Am J Surg. 158 (6): 563–6. PMID 2589590.
  2. Hendrix TR (1980). "Schatzki ring, epithelial junction, and hiatal hernia--an unresolved controversy". Gastroenterology. 79 (3): 584–5. PMID 7429120.
  3. Bakari G, Benelbarhdadi I, Bahije L, El Feydi Essaid A (2014). "Endoscopic treatment of 135 cases of Plummer-Vinson web: a pilot experience". Gastrointest Endosc. 80 (4): 738–41. doi:10.1016/j.gie.2014.05.332. PMID 25085338.
  4. Bakshi SS (2016). "Plummer-Vinson Syndrome". Mayo Clin Proc. 91 (3): 404. doi:10.1016/j.mayocp.2015.11.002. PMID 26944249.
  5. Lind CD (2003). "Dysphagia: evaluation and treatment". Gastroenterol Clin North Am. 32 (2): 553–75. PMID 12858606.
  6. Navaneethan, Udayakumar; Eubanks, Steve (2015). "Approach to Patients with Esophageal Dysphagia". Surgical Clinics of North America. 95 (3): 483–489. doi:10.1016/j.suc.2015.02.004. ISSN 0039-6109.
  7. Scheurer U (1991). "[Dysphagia]". Ther Umsch. 48 (3): 150–61. PMID 2042117.

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