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.
    • Treatment
      • 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.

Bibliography

  • ACP MKSAP 17:  Gastroenterology and Hepatology, pgs. 1-2
  • Image:  F. Netter Anatomy illustration

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