The very first entry in my GI & Hepatology study outline series will set the stage/define major descriptors of proximal GI (esophageal) symptoms and help with categorizing pathology.
Dysphagia = the sensation that food and/or liquid is not appropriately going through the mouth/throat/esophagus. Typical symptoms: “food is getting stuck / impeded.”
- Oropharyngeal phase – food bolus from mouth into hypopharynx and proximal esophagus
- “Transfer Dysphagia” – cannot START the swallow maneuver.
- Symptoms: coughing, food entering nares, choking; hoarseness and/or dysarthria (neuromuscular weakness/dysfunction)
- At direct aspiration risk due to inability to clear food/liquid from epiglottis (look for perpetual pulmonary infections)
- Examples: cricoid webs, iron deficiency, mass compression, ALS, stroke, dementia, Myasthenia Gravis.
- Best initial test = modified barium swallow (videofluoroscopy)
- Test begins with liquid phase, proceeded by solid phase
- If overall test is normal, symptoms are NOT oropharyngeal in nature.
- Dietary modification and swallow exercises (speech language pathology)
- Esophageal phase – from proximal esophagus to stomach.
- Symptoms: lower chest discomfort, can be to solids (mechanical blockage) or liquids (motility issue) or both solids/liquids (motility).
- Examples: Achalasia, systemic sclerosis, strictures, cancer, vascular dysphagia, Schatzki ring, or webs
- Best initial test = upper endoscopy (EGD)
Pyrosis = heartburn, or regurgitation of gastric (acidic) material into esophagus. #1 GI complaint in the US. Think about it if symptoms occur 1 hour after eating. Must first rule out cardiac problems!
Odynophagia = PAIN with swallowing, related to inflammation and mucosal damage.
Globus feeling = symptoms include lump/ball in throat, can be constant when patient is not swallowing. Consider barium swallow or nasal endoscopy to rule out organic disease.
- ACP MKSAP 17: Gastroenterology and Hepatology, pgs. 1-2
- Image: F. Netter Anatomy illustration