Dysphagia describes a subjective awareness of swallowing difficulty during the passage of a bolus from the mouth to the stomach or the perception of obstruction during swallowing.
It suggests the presence of an organic abnormality in the passage of solids or liquids from the oral cavity to the stomach.
It is a common clinical problem and its prevalence is increasing,
afecting 13.5% of the general population.
It is also an alarm symptom that warrants immediate evaluation to define the exact cause and initiate appropriate therapy.
Dysphagia can be caused by functional or structural abnormalities affecting the oral cavity,
esophagus and/or gastric cardia.
It can be divided in two groups,
oropharyngeal dysphagia or esophageal dysphagia,
and this classification has implications in potential causes,
radiologic evaluation and treatment.
Oropharyngeal dysphagia refers to a difficulty initiating a swallow.
It can be sensed as a blockage or discomfort in the throat,
which may be accompanied by coughing,
aspiration and a sensation of residual food remaining in the pharynx.
It may my caused by pathology from the pharynx,
esophagus or gastric cardia,
but is more common in patients with a history of neurologic disorders such as stroke,
head and neck surgery or radiation therapy.
In esophageal dysphagia the patient localizes the discomfort or blockage in swallowing between the thoracic inlet and the xiphoid process,
in the region of the thoracic esophagus.
It is typically caused by disease in the esophagus or the proximal stomach.
Although endoscopy is usually the first exam in the investigation of dysphagia,
barium swallow tests still give important information about the anatomy and function of the swallowing mechanism.
Therefore it is important to be aware of the most common possible causes and findings.
Barium swallow tests should be performed prior to upper endoscopy in patients with a history or clinical features suggestive of a proximal esophageal lesion (eg,
surgery for laryngeal or esophageal cancer,
or radiation therapy) or a known complex stricture (eg,
postcaustic injury or radiation therapy).
In these situations,
the blind intubation of the proximal esophagus during upper endoscopy may be associated with an higher risk of perforation due to upper esophageal pathology.
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They should be performed after a negative upper endoscopy in patients in whom a mechanical obstruction is still suspected,
as lower esophageal rings or extrinsic esophageal compression can be missed by upper endoscopy.