The term also gives no clue as to whether the problem is primarily a motor or sensory one. Typically, patients complain of the feeling of food/drink sticking, or a discomfort either in the throat or retrosternally, or simply being able to “sense” the act of swallowing; occasionally, regurgitation, aspiration, or even hiccup may be the presenting complaint.2

The most important first step in assessing dysphagia is to determine whether it is oropharyngeal or esophageal in origin, as their potential causes and subsequent investigation and management can differ greatly. This can Pexidartinib supplier usually be achieved through taking a careful history, which has been shown to accurately differentiate between oropharyngeal, esophageal, and neuromuscular causes of dysphagia in up to 85% of patients.3 It is important to know if the dysphagia is present only during swallowing or at all times, the latter suggests potential sensory dysfunction, and the most common disorder is globus hystericus. Dysphagia that occurs only during swallowing of solids is more likely to indicate underlying mechanical obstruction, whereas when both solids and liquids are affected, dysmotility is the likely cause. The presence of symptoms such as delayed or absent swallow initiation, Selumetinib order cough post-swallowing, nasopharyngeal

regurgitation, and repeated swallows to effect pharyngeal clearance, indicate potential oropharyngeal dysphagia.2 Localization of the hold-up site based on symptom is not always a reliable guide to the site of the obstruction.2,4 However, dysphagia felt in the throat is more likely to be oropharyngeal in origin as compared with that in the retrosternal region, which is more suggestive of an esophageal disorder. The duration and progression of symptoms are also important features. Chronic and stable symptoms suggest benign conditions such as peptic strictures or Schatzki’s ring, while rapidly progressive symptoms, especially in association with weight loss, indicate a more sinister cause. The presence of regurgitation immediately after swallowing suggests esophageal retention of food, whereas regurgitation in between meals indicates the presence

of a pharyngeal pouch or Zenker’s diverticulum. Dysphagia that occurs after a long history of reflux symptoms, especially with patients giving a history of poor symptom control, may suggest the development click here of complications such as peptic stricture, Barrett’s esophagus and possibly, esophageal adenocarcinoma. Patients with known esophageal dysmotility often have volume reflux, and throat irritation caused by reflux can induce the sensation of dysphagia. In young patients who present with dysphagia or food bolus obstruction, especially those with a history of atopy, eosinophilic esophagitis must be suspected and esophageal biopsies must be performed on subsequent gastroscopy. Dysphagia may be a complication of systemic disease or medication.