Dysphagia

Dysphagia is a symptom defined as difficulty swallowing or a sensation of food sticking in the throat or chest. It can involve solids, liquids, or both and may reflect problems in the mouth, pharynx, esophagus, or in the nerves and muscles that coordinate swallowing.

Dysphagia is commonly classified as oropharyngeal or esophageal. Oropharyngeal dysphagia presents with coughing or choking during meals, nasal regurgitation, drooling, or the need to swallow multiple times. Esophageal dysphagia causes a feeling of food sticking behind the sternum and may be intermittent or progressive.

Causes include neurologic and neuromuscular disorders (stroke, Parkinson disease, amyotrophic lateral sclerosis), structural lesions such as benign strictures, rings, diverticula, peptic stricture, or cancer; motility disorders such as achalasia and diffuse esophageal spasm; inflammatory conditions (gastroesophageal reflux disease, eosinophilic esophagitis); and age-related changes or medication effects.

Evaluation begins with history and examination, followed by targeted tests. Oropharyngeal dysphagia is assessed with videofluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES). Esophageal disease is investigated with endoscopy and biopsy, barium swallow, and esophageal manometry. In selected cases, pH testing or imaging may help identify reflux or aspiration.

Management aims to treat the underlying cause and may include dietary modification, swallow therapy, postural adjustments, and treatment of reflux. Mechanical obstruction may require dilation or stenting; motility disorders may be treated with medications or procedures such as myotomy. Prognosis depends on the underlying disorder and the timeliness of treatment.