Esophageal Dysphagia Transport of ingested material from the proximal esophagus to the stomach may be impaired by two mechanisms: (a) motor abnormalities of the esophagus and its lower sphincter, and (b) structural abnormalities of the esophagus. Disorders of the former type commonly produce difficulty in swallowing liquids as well as solids, ... Article
Article  |   June 01, 2003
Esophageal Dysphagia
Author Affiliations & Notes
  • Reza Shaker
    Medical College of Wisconsin, Milwaukee, WI
  • Reza Shaker is a tenured professor of Medicine, Radiology and Otolaryngology at the Medical College of Wisconsin. He is Chief of the Division of Gastroenterology and Hepatology and Director of the Digestive Disease Center. Dr. Shaker is the founder of the Dysphagia Research Society and MCW’s Dysphagia Institute. Her e-mail address is rshaker@mcw.edu.
Article Information
Swallowing, Dysphagia & Feeding Disorders / Articles
Article   |   June 01, 2003
Esophageal Dysphagia
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), June 2003, Vol. 12, 8-12. doi:10.1044/sasd12.2.8
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), June 2003, Vol. 12, 8-12. doi:10.1044/sasd12.2.8
Transport of ingested material from the proximal esophagus to the stomach may be impaired by two mechanisms: (a) motor abnormalities of the esophagus and its lower sphincter, and (b) structural abnormalities of the esophagus. Disorders of the former type commonly produce difficulty in swallowing liquids as well as solids, progress slowly, and can occur intermittently (see Table). On the other hand, structural lesions of the esophagus, unless they induce near complete or complete obliteration of the lumen, usually cause solid food dysphagia only. Rapid progression of dysphagia is suggestive of malignancy, whereas slow progression is more common in a benign condition such as peptic strictures. A thorough history and physical examination are extremely helpful, but diagnostic tests are required to establish the specific diagnosis. A history of chronic heartburn with dysphagia suggests peptic stricture. However, the possibility of Barrett’s esophagitis with malignant transformation resulting in dysphagia needs to be ruled out. In addition, queries need to be made about odynophagia (painful swallowing), which suggests infectious esophagitis. Ingestion of quinidine, tetracycline, doxy-cycline, or potassium chloride pills can induce mucosal lesions and odynophagia. Evidence of significant weight loss favors malignancy. Raynaud’s phenomenon or sclerodactyly may indicate esophageal involvement in systemic sclerosis.
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