Dysphagia is an alarming symptom that requires prompt evaluation to determine the cause and to initiate treatment. It may be due to a structural or motility (movement) abnormality as solids or liquids pass from the mouth to the stomach.
Often, patients confuse dysphagia with odynophagia or a globus sensation. Dysphagia is a subjective sensation of difficulty or abnormality of swallowing. Odynophagia is pain with swallowing. A globus sensation is a nonpainful sensation of a lump, tightness, foreign body or retained food bolus in the neck or upper chest region.
Dysphagia in older adults should NOT be attributed to normal aging. Aging alone causes mild esophageal motility (movement) abnormalities, which are rarely troublesome.
Dysphagia can be classified as acute or nonacute. The acute onset of the inability to swallow solids and/or liquids (including saliva) is likely related to an esophageal foreign body impaction. Food impaction is the most common cause of acute dysphagia in adults. The estimated incidence of esophageal food impaction is 25 per 100,000 persons per year. The incidence is higher in males and increases with age. A food impaction necessitates immediate medical attention.
Medication can be administered to attempt to relax the lower esophageal sphincter and promote passage of the food bolus.
The food impaction may require upper endoscopy to either remove the food bolus or gently push the bolus into the stomach with the endoscope.
The first step in evaluating patients with nonacute dysphagia is to determine if the symptoms are due to oropharyngeal dysphagia or esophageal dysphagia based on patient history. In this article, we will focus on esophageal dysphagia.
In esophageal dysphagia, patients commonly report difficulty swallowing several seconds after initiating a swallow and a sensation that foods and/or liquids are not adequately passing from the upper esophagus to the stomach.
An important component of the medical history is determining what types of food (i.e., solids, liquids or both) produce symptoms. Dysphagia to both solids and liquids from the onset of symptoms is likely due to a motility (movement) disorder of the esophagus. Dysphagia to solids only is usually present when the esophageal lumen is narrowed (e.g., by a stricture).
Additional symptoms associated with dysphagia can provide a clue to the possible cause. For example, patients with chronic heartburn who develop dysphagia may have a stricture, erosive esophagitis, or cancer of the esophagus. Patients with esophageal cancer tend to be older males with significant weight loss.
Patients undergoing radiation therapy for chest, head or neck tumors are at risk for developing esophagitis and esophageal strictures. This may result in odynophagia or dysphagia.
Brenda Keller, APRN-CNP
Gastroenterology Associates of Northwest Ohio
