Dysphagia

General Info	HPI/Physical
When trying to evaluate a patient for difficulty swallowing it can be helpful to distinguish where the patient feels they are having difficulty. If the problem is in the upper esophagus it is more likely a neuromuscular disease and difficulty in the lower esophagus is more likely secondary to obstruction.	Symptoms: Coughing, choking with swallowing, food sticking in the throat, regurgitation, sialorrhea, unexplained weight loss, change in dietary habits, recurrent pneumonia, change in voice or speech.

Differential

Neuromuscular Disease	Obstructive Disease	Due to Medication/Disease
CVA/Stroke Parkinson disease Brainstem tumors ALS Multiple sclerosis (MS) Myasthenia gravis Muscular dystrophy	Foreign Body Achalasia Scleroderma Diffuse Esophageal Spasm Webs/Rings Barrett’s Esophagus Esophageal Cancer	Hyper/Hypothyroidism

Tests/Diagnosis	Management	Disposition
Chest X-ray Serum Protein/Albumin Medicine Work-up: Swallow Evaluation Endoscopy Fiberoptic endoscopic examination of swallowing (FEES) Manometry CT Neck/Chest TFTs	Treat underlying disease IV Fluids if dehydrated Dietary Modifications	Patient can be discharged home if tolerating PO with follow up for outpatient work-up. Make sure no odynophagia which has different management