Dysphagia - Differential Diagnosis

Differential Diagnosis

Dysphagia is classified into two major types:

1. oropharyngeal dysphagia and
2. esophageal dysphagia.
3. functional dysphagia is defined in some patients as having no organic cause for dysphagia that can be found.

Causes of oropharyngeal dysphagia include:

• Cerebrovascular Stroke
• Multiple Sclerosis
• Myasthenia gravis
• Parkinson's disease & Parkinsonism syndromes
• Amyotrophic Lateral Sclerosis
• Bell's palsy
• Bulbar Palsy & Pseudobulbar palsy
• Xerostomia
• Radiation
• Neck malignancies
• Neurotoxins (e.g. snake venom)
• Eosinophilic esophagitis
• Pharyngitis, etc.

Please refer to Etiology and Differential Diagnosis on the oropharyngeal dysphagia page for a more extensive list.

Causes of esophageal dysphagia can be divided into mechanical and functional causes.

• Functional causes include
  • achalasia,
  • myasthenia gravis,
  • bulbar or pseudobulbar palsy,
  • systemic sclerosis
• Mechanical causes include
  • peptic esophagitis,
  • carcinoma of the esophagus or gastric cardia
  • external compression of the esophagus, such as obstruction by lymph node and left atrial dilatation in mitral stenosis.
  • Candida esophagitis,
  • pharyngeal pouch,
  • esophageal web,
  • esophageal leiomyoma,
  • systemic sclerosis

Esophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids. In fact, so far, there are no scientific study that proves that those thickened liquids are beneficial. Dehydration and or undernutrition can be a result of those restriction and worsen the risk of aspiration pneumonia.