When it's hard to swallow. What to look for in patients with dysphagia.

Swallowing disorders can be divided into oropharyngeal dysphagia and esophageal dysphagia. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents; other causes may include oropharyngeal structural lesions, systematic and local muscular diseases, and diverse neurologic disorders. Esophageal dysphagia may result from neuromuscular disorders, mortality abnormalities, and intrinsic or extrinsic obstructive lesions. Through clinical history taking helps define the tpe of dysphagia and can guide diagnostic testing. Important questions to ask patients with the disorder include specific features of the dysphagia, its onset and progression, accompanying problems, and eating habits adopted to relieve symptoms. Videofluoroscopy should be the initial test in evaluating oropharyngeal dysphagia. Barium-contrast esophagography identifies most anatomic causes of dysphagia and some motor disorders and is better tha endoscopy at identifying extrinsic esophageal compression and intramural lesions not involving the esophageal mucosa. Cine-esophagography may provide clues to a possible esophageal motor disorder causing dysphagia. Endoscopy is the test of choice if obstruction or gastroesophageal reflux disease is suspected, because biopsies can confirm the presence of esophagitis and provide specific pathologic identification of the obstructive lesion. In addition, therapeutic dilatation of a stricture and removal of foreign bodies can be accomplished as part of the evaluation procedure. When no obvious source of dysphagia is apparent after radiologic and endoscopic assessment, manometry for possible motility disorder should be considered.