As noted above, historical information is key to the diagnosis of dysphagia. Ia.ble.Z.l-l summarizes some of the clinical features of transfer versus transport dysphagia. Though often occurring as an independent symptom, dysphagia can be associated with odynophagia, which is painful swallowing (suggesting an inflammatory process), or with chest pain that is esophageal in nature and suggests gastroesophageal reflux disease (GERD) or a motility disorder. Additional pertinent historical features to elicit in a patient complaining of dysphagia include the following: Has this been an acute, subacute, or chronic course? Is the dysphagia present for solids, liquids, or both? Is it intermittent or progressive? Is there a sensation of the food being stuck in the esophagus, and where? Is there any past history of esophageal disease? Transport dysphagia that is present for solids only generally suggests a mechanical/obstructive process. Motility disorders typically cause transport dysphagia for solids and liquids.
A poorly chewed meat bolus that impacts in the esophagus is a well-recognized complication of esophageal disease. A preceding history of dysphagia may or may not be obtained. Ihis can be the presenting complaint of a patient with a variety of esophageal pathologies. Ihe bolus may be well localized by the patient; in general, patients able to identify a level of dysphagia below the neck are usually anatomically accurate, whereas those complaining of dysphagia in the neck may be reporting sensations referred from elsewhere in the esophagus.7 Esophageal filling proximal to the impacted bolus may make the patient unable to swallow secretions and may present an airway/aspiration risk.
Physical examination of patients with dysphagia should focus on the head and neck and the neurologic exam. Signs of previous cerebrovascular accident, muscle disease, or Parkinson's disease can be present. Cachexia and cervical or supraclavicular nodes can be observed in patients with cancer of the esophagus. Watching the patient as he or she takes a small sip of water can also provide very valuable information. Unfortunately, the physical examination is often normal in patients with dysphagia, despite the high yield nature of this complaint.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.