Approach to dysphagia
Murtagh's diagnostic models
** Excluding oropharyngeal infections and strokes**** Although dysphagia is a common psychogenic symptom, it must always be taken seriously and investigated.**
Probability diagnosis
- Functional
- Tablet-induced irritation
- Pharynotonsillitis
- Reflux oesophagitis
Serious disorders not to be missed
- Neoplasia
- Cancer of the pharynx, oesophagus, stomach
- extrinsic tumour
- AIDS (opportunistic oesophageal infection)
- Stricture, usually benign peptic stricture
- Scleroderma
- Neurological causes:
- pseudobulbar palsy
- multiple sclerosis
- motor neurone disease (amyotrophic sclerosis)
- Parkinson disease
Pitfalls (often missed)
- Foreign body
- Drugs
- Subacute thyroiditis
- Extrinsic lesion (lymph nodes, goitre)
- Upper oesophageal web (e.g. Plummer-Vinson syndrome)
- Eosinophlic oesophagitis
- Radiotherapy
- Achalasia
- Upper oesophageal spasm
- Globus sensation
- Rarities
- sjogren syndrome
- aortic aneurysm
- aberrant right subclavian artery
- lead poisoning
- cervical osteoarthritis (large osteophytes)
- other neurological causes
- other mechanical causes
Red Flag Pointers
- Age > 50
- Recent or sudden onset
- unexplained weight loss
- Painful swalloing
- Progressive dysphagia
- Dysphagia for solids
- Hiccoughs
- Hoarseness
- Neurological symptom/signs
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