Dysphagia

Lesson 1

Medical English
Raina/Chaw/Jason
§ Lesson 1: Definition, Causes, Diagnostic Approach
§ Lesson 2: Differential Diagnoses
§ Lesson 3: Mini-cases

§ Lesson 4: Review session

§ A 52-year-old gentleman comes to your office with a history of
intermittent difficulty swallowing solid food. His symptoms
have been present for the past 5 years. He points to his
supraclavicular notch when describing where the food feels
stuck, although he is able to chew his food and transfer it into
his posterior pharynx without difficulty. He does not choke or
cough while eating. Drinking water will usually relieve his
symptoms, although on several occasions he has self-induced
vomiting. His symptoms are slightly worse now than they were
several years ago, which prompted today's visit.
§ What is the difference between dysphaGia
and dysphaSia?
DysphaGia = difficulty in swallowing
DysphaSia = difficulty in speaking
https://www.youtube.com/watch?v=KNYgbN9SIfk
1 2 3

Oral Phase Pharyngeal Phase Esophageal Phase

Voluntary Control Involuntary Control

Tongue and saliva Peristalsis movements

Anatomical Orientation and Neurological Control

Larynx
Pharynx
喉頭
咽頭
(こうとう）
(いんとう)
 Pharynx Vs Larynx
No. Parameters Pharynx Larynx
1 Location Behind oral and nasal At 3rd – 6th cervical
cavities vertebral disc
2 System Part of digestive and Part of respiratory
respiratory
3 Anatomical Connect mouth to Connect to the trachea
relation esophagus, nose to
larynx
4 Anatomy Three regions - Cartilages:
Nasopharynx Cricoid cartilage
Oropharynx Thyroid cartilage
Laryngopharynx Arytenoid cartilage

5 Walls Muscular walls Walls formed by

cartilage
6 Vocal cord Nil Presence
 SWALLOWING MECHANISM
Airway remains open Inhibits respiration

Voluntary Control Involuntary Control

Oral Phase Pharyngeal Phase Esophageal Phase

Ø Food is chewed to form a Ø Bolus is advanced into the Ø Esophageal peristalsis

bolus by saliva pharynx and entered into involuntarily
Ø Food bolus is moved to the the esophagus by Ø Lower esophageal sphincter
pharynx by tongue pharyngeal muscle relaxation
voluntarily peristalsis Ø Food bolus enter into the
Ø This leads to stimulation of Ø Peristalsis is controlled stomach
swallowing reflex involuntarily Ø Involves cranial nerves (CN)
Ø Involves cranial nerves (CN) Ø Involves cranial nerves IX and X.
V, VII and XII. (CN) V, IX, X and XII.
(Please see the next page for the name of CN)
 Bonus Questions (You do not need to memorize this)

Ø How many muscles are involved in swallowing?

Ø What are they?

CN IX

CN XII

CN X

Phys Med Rehabil Clin N Am. 2008 Nov; 19(4): 691–707.

Medical Term Definition
Dysphagia _______________ in swallowing
Odynophagia _______________ during swallowing
Reflux/ Regurgitation Food or gastric secretions come back to the
throat or mouth;
“____________________”

Aspiration Food or drink goes down to the

_______________ instead of the esophagus
Gagging Food or drink may cause patient to throw up
or vomit;
“___________________”

Globus Pharyngeus Sensation of a ____________________ in the

throat _________________ to swallowing
Xerostomia ______________________________
Unintentional weight loss Losing weight _______________________
§ Dysphagia: The patient might say - ‘it’s hard (difficult) to
swallow.’
§ Odynophagia: The patient might say – ‘it hurts (it’s painful) to
swallow.’
§ Reflux: A common expression is- ‘to have/get heartburn.’

§ Aspiration: The patient might say- ‘my food goes down the
wrong way.’
§ Globus Pharyngeus: The patient will probably say- ‘I feel like I
have/I get a lump in my throat.’
 Oropharyngeal
Difficulty initiating swallowing
and may have nasopharyngeal
regurgitation, aspiration, and a
sensation of residual food
remaining in the pharynx.
Difficulty transferring food from
the mouth to the pharynx and
report a feeling of an
obstruction in the neck
Esophageal
Characterized by difficulty
swallowing several seconds after
initiating a swallow
Sensation of food getting stuck in
the esophagus after initiating a
swallow
1. Congenital
2. Infection
3. Trauma
4. Inflammatory
5. Autoimmune
6. Neoplastic
7. Neurological
8. Motility disorders
9. Iatrogenic
 Oropharyngeal
• Laryngeal cancer
• Pharyngeal cancer
• Stroke
• Parkinson’s Disease
• Neuromuscular dysfunction
Esophageal
• Achalasia
• Esophageal cancer
• Eosinophilic Esophagitis
• Peptic stricture
• Lower esophageal ring
• Plummer-Vinson Syndrome
https://www.youtube.com/watch?v=KNYgbN9SIfk
ü Description of what ü Determine whether
happens when swallowing symptoms are progressive
ü Types of food resulting in or intermittent
dysphagia (solid, liquid, or ü Any associated symptoms
both) or comorbid conditions,
ü Time course of dysphagia such as history of stroke,
ü Onset, duration, neurologic disorders,
frequency, location, and tobacco use, or history of
precipitating or alleviating reflux disease
factors ü Presence of alarm
symptoms
ü Weight loss
ü Hematemesis
ü Rapidly progressing dysphagia
ü Respiratory symptoms
ü Advanced age
https://www.youtube.com/watch?v=KNYgbN9SIfk
§ A 52-year-old gentleman comes to your office with a history of
intermittent difficulty swallowing solid food. His symptoms
have been present for the past 5 years. He points to his
supraclavicular notch when describing where the food feels
stuck, although he is able to chew his food and transfer it into
his posterior pharynx without difficulty. He does not choke or
cough while eating. Drinking water will usually relieve his
symptoms, although on several occasions he has self-induced
vomiting. His symptoms are slightly worse now than they were
several years ago, which prompted today's visit.
§ His symptoms typically happen shortly after
swallowing solid food, particularly when he is eating
fast and takes a large bite of food such as bread or
meat. He does not have difficulty swallowing liquids.
The longest he has had food stuck has been 30
minutes, during which time he had severe pain in his
chest. He reports rare episodes of heartburn and
regurgitation, which have been relieved with
antacids. He denies smoking or excessive alcohol
use.
§ Would you classify his dysphagia as
esophageal or oropharyngeal?
§ Distinguish
between oropharyngeal and esophageal
dysphagia at the beginning of the interview.
§ Theduration and frequency of a patient's dysphagia
provide useful clues and can help make the
diagnosis.
§ Dysphagia to solid food is most often due to a
mechanical obstruction, whereas dysphagia to solid
and liquid food is often due to a motor (motility)
disorder.