Sagittal and diagrammatic views of the musculature involved in enacting oropharyngeal swallowing.
Thanks to Dr. Elliot Ho for discussing a case of dysphagia secondary to gastric adenocarcinoma of the GE junction.
Learning points:
— Nomenclature:
- Dysphagia: difficulty with swallowing
- Odynophagia: pain with swallowing
- Aphagia: inability to swallow
- Phagophobia: fear of swallowing
— There is a broad, but a structured differential can be created with the following categories:
- Oropharyngeal vs. esophageal
- Mechanical vs. motor
- Extrinsic vs. intrinsic.
— History is key:
- Dysphagia to solids + liquids suggests motor
- Dysphagia to solids progressing to liquids suggestive mechanical.
- Screen associated sx for possible neuromuscular, malignant, or infectious source.
- Ferrous sulfate + alendronate frequent cause of pill esophagitis
— Barium swallow may be better than EGD for webs, rings, and linitis plastica.