Dysphagia: Clinical Evaluation, Assessment and Management

Abstract

Dysphagia is a common problem affecting all ages. It’s divided into oropharyngeal dysphagia and esophageal dysphagia. Oropharyngeal dysphagia manifests as difficulty initiating swallowing, coughing, choking, or aspiration, and it is most commonly caused by chronic neurologic conditions such as stroke, Parkinson disease, or dementia, and Obstructive (oropharyngeal) symptoms that seem to originate in the throat or neck may actually be caused by distal esophageal lesions. Patients with esophageal dysphagia may report a sensation of food getting stuck after swallowing. This condition is most caused by gastro esophageal reflux disease and functional esophageal disorders. Eosinophilic esophagitis is triggered by food allergens and is increasingly prevalent. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus esophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined according th the eventual diagnosis, often in a multi-disciplinary setting.