Paucis Verbis card: Dysphagia

Dyphagia is a disorder of swallowing. It actually occurs in up to 10% of adults older than 50 years old. How can you determine the most likely causes for dysphagia? The secret is to obtain a thorough history and using the algorithm below, which I find really helpful from a review article in American Family Physician.

How do you read the figure?

• Determine first if patient has oropharyngeal vs esophageal dysphagia.
• Determine if mechanical (problem is solid foods only) vs neuromuscular (problem with liquids and solids)is more likely.

Tip:

• Medications can cause dysphagia from esophageal mucosal injury or reduced lower esophageal sphincter tone.
• CVA is most common cause of oropharyngeal dysphagia

Workup:

• Endoscopy
• Barium swallow
• Consider esophageal pH probe, manometry

PV Card: Dysphagia

Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

1. Spieker M. Evaluating dysphagia. Am Fam Physician. 2000;61(12):3639-3648. [PubMed]

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