VA AM Report 3.7.17: Dysphagia

Abdul taught as all about esophageal dysphagia today. Quick pearls:

#Loved his approach, we usually know esophageal vs oropharyngeal dysphagia, but how do you break down esophageal dysphagia?
-Infectious Causes-Mass lesions
-Motility issues
-Toxic/corrosive causes
-Anatomic variants (hiatal hernia, diverticula, extrinsic compression)

#Infectious causes of esophagitis that can lead to strictures, narrowing etc. include candida, HSV, CMV, endemic mycoses, always remember TB and NTBM.

#Toxic/corrosive, think ingestions. One hundred percent ethanol, propyl alcohol, hydrogen peroxide, lye, any caustic substance really can cause a chemical esophagitis and progressive narrowing

#Always consider food impaction! Usually as a result of the underlying dysphagia, but this is a GI emergency!

#Motility includes achalasia, scleroderma, Sjogren’s, nutcracker esophagus, esophageal spasm etc.

External compression can result from any mass (malignancy, lymph nodes), as well as great vessel abnormalities can cause esophageal dysphagia. This is where a barium swallow can be a helpful adjunctive test prior to a EGD, can pick up aberrant aortic arches, large left atrium, or a diverticula.

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