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Dysphagia
Essentials
- 1
Dysphagia is a diagnostic challenge and a broad differential diagnosis should be considered. A carefully taken history will reveal the likely cause in most cases.
- 2
Dysphagia due to a new-onset stroke, pharyngeal or oesophageal disorder will increase the amount of food in the pharynx and may be complicated by aspiration. An assessment of that risk should be made before allowing the patient to take oral fluids or food.
- 3
Patients with moderate- to long-term dysphagia may have significant fluid and electrolyte abnormalities and severe nutritional disturbances.
- 4
Emergency department investigations should be directed to the detection of high-grade obstructions and lesions causing significant risks from airway compromise, haemorrhage or sepsis.
- 5
Dysphagia is very rarely caused by a psychological disorder. There is nearly always a physical cause.
Introduction
Dysphagia is a broad term encompassing the many forms of difficulty with deglutition (swallowing). The main issues are to determine the likely cause, to identify those patients at risk of significant complications, to treat those causes that are amenable to acute intervention and to refer appropriately for further investigations and treatment.
Dysphagia may be associated with odynophagia (pain on swallowing). Globus is a related term meaning the sensation of a lump in the throat. This is rarely of psychological origin. Since the advent of sophisticated investigative techniques, it has been recognized that there is an identifiable physical cause in the great majority of cases.
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