Common gastrointestinal symptoms: dysphagia.

Swallowing occurs in 3 phases: oral, pharyngeal, and esophageal. Oropharyngeal dysphagia typically is a result of neuromuscular disorders, such as stroke and parkinsonism, or of mucosal dryness caused by drugs or radiation therapy. Esophageal dysphagia is commonly caused by anatomic defects of the esophagus, such as reflux disease; motility disorders, such as achalasia; or eosinophilic esophagitis. If oropharyngeal dysphagia is suspected, the patient should undergo initial testing with a water or semisolid bolus swallow test. If results are positive, the diagnosis can be confirmed with a videofluoroscopic swallowing study. If esophageal dysphagia is suspected, patients typically undergo endoscopic esophagogastroduodenoscopy. Management of confirmed oropharyngeal dysphagia involves short-term compensation strategies, such as postural changes or food thickening, to minimize the risk of aspiration. This is followed by rehabilitation that may involve swallowing exercises with biofeedback or electrical stimulation of the swallowing muscles. Some patients may need enteral feeding. For esophageal dysphagia, choice of management depends on the etiology; it may include endoscopic dilation, myotomy, injection of onabotulinumtoxinA (formerly called botulinum toxin type A) for structural abnormalities, or topical steroid therapy for eosinophilic esophagitis.