Dysphagia causes: Difference between revisions

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Antipsychotic medications, [[Hyoscyamine]], [[Minocycline hydrochloride]], [[Nabumetone]], [[Oxcarbazepine]]
Antipsychotic medications, [[Hyoscyamine]], [[Minocycline hydrochloride]], [[Nabumetone]], [[Oxcarbazepine]], [[Ropinirole]]
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Revision as of 20:10, 20 November 2014

Dysphagia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Farman Khan, MD, MRCP [2]

Causes

Common Causes of Oropharyngeal Dysphagia

Common Causes of Esophageal Dysphagia

  • Peptic stricture, or narrowing of the esophagus, is usually a complication of acid reflux, most commonly due to gastroesophageal reflux (GERD). These patients are usually older and have had GERD for a long time. Acid reflux can also be due to other causes, such as Zollinger-Ellison syndrome, NG tube placement, and scleroderma. Other non-acid related causes of peptic strictures include infectious esophagitis, ingestion of chemical irritant, pill irritation, and radiation. Peptic stricture is a progressive mechanical dysphagia, meaning patients will complain of initial intolerance to solids followed by inability to tolerate liquids. Usually the threshold to solid intolerance is 13 mm of the esophageal lumen. Symptoms relating to the underlying cause of the stricture usually will also be present.
  • Esophageal cancer also presents with progressive mechanical dysphagia. Patients usually come with rapidly progressive dysphagia first with solids then with liquids, weight loss (> 10 kg), and anorexia (loss of appetite). Esophageal cancer usually affects the elderly. Esophageal cancers can be either squamous cell carcinoma or adenocarcinoma. Adenocarcinoma is the most prevalent in the US and is associated with patients with chronic GERD who has developed Barrett's esophagus (intestinal metaplasia of esophageal mucosa). Squamous cell carcinoma is more prevalent in Asia and is associated with tobacco smoking and alcohol use.
  • Esophageal rings and webs, are actual rings and webs of tissue that may occlude the esophageal lumen.
    • Rings --- Also known as Schatzki rings from the discoverer, these rings are usually mucosal rings rather than muscular rings, and are located near the gastroesophageal junction at the squamo-columnar junction. Presence of multiple rings may suggest eosinophilic esophagitis. Rings cause intermittent mechanical dysphagia, meaning patients will usually present with transient discomfort and regurgitation while swallowing solids and then liquids, depending on the constriction of the ring.
    • Webs --- Usually squamous mucosal protrusion into the esophageal lumen, especially anterior cervical esophagus behind the cricoid area. Patients are usually asymptomatic or have intermittent dysphagia. An important association of esophageal webs is to the Plummer-Vinson syndrome in iron deficiency, in which case patients will also have anemia, koilonychia, fatigue, and other symptoms of anemia.
  • Achalasia is an idiopathic motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation as well as loss of peristalsis in the distal esophagus, which is mostly smooth muscle. Both of these features impair the ability of the esophagus to empty contents into the stomach. Patients usually complain of dysphagia to both solids and liquids. Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn. The combination of achalasia, adrenal insufficiency, and alacrima (lack of tear production) in children is known as the triple A (Allgrove) syndrome. In most cases the cause is unknown (idiopathic), but in some regions of the world, achalasia can also be caused by Chagas disease due to infection by Trypanosoma cruzi.
  • Scleroderma is a disease characterized by atrophy and sclerosis of the gut wall, most commonly of the distal esophagus (~90%). Consequently, the lower esophageal sphincter cannot close and this can lead to severe gastroesophageal reflux disease (GERD). Patients typically present with progressive dysphagia to both solids and liquids secondary to motility problems or peptic stricture from acid reflux.
    • DES can be caused by many factors that affect muscular or neural functions, including acid reflux, stress, hot or cold food, or carbonated drinks. Patients present with intermittent dysphagia, chest pain, or heartburn.

Causes by Organ System

Cardiovascular

Aortic arch anomalies, aberrant subclavian artery, anomalous left pulmonary artery , double aortic arch, large aneurysm of the thoracic aorta, mitral stenosis, right aortic arch , superior vena cava syndrome, thoracic aortic aneurysms

Chemical / poisoning

Arsenic poisoning, botulism, cyclosporine toxicity, fluoride poisoning, lead poisoning,


Dermatologic

Dermatomyositis, polymyositis

Drug Side Effect

Antipsychotic medications, Hyoscyamine, Minocycline hydrochloride, Nabumetone, Oxcarbazepine, Ropinirole

Ear Nose Throat

Palatine tonsil, pharyngeal pouch, pharyngitis, quinsy, retropharyngeal abscess

Endocrine

De Quervain's thyroiditis, diabetic neuropathy, solitary thyroid nodule, thymoma, thyroglossal cyst

Environmental No underlying causes
Gastroenterologic

Barrett's esophagus, Plummer-Vinson syndrome, achalasia, adjustable gastric band, diffuse esophageal spasm, eosinophilic esophagitis, esophageal cancer, esophageal food bolus obstruction, esophageal foreign body, esophageal web, gastroesophageal reflux disease, gastrointestinal stromal tumor, globus pharyngis, hiatus hernia, hypertensive lower esophageal sphincter, Ludwig's angina, lymphocytic esophagitis, Nissen fundoplication, nutcracker esophagus, odynophagia, oropharyngeal cancer, Ortner's syndrome, palate cancer, palatine tonsil, pharyngeal pouch, pharyngitis pill esophagitis, post surgery (laryngeal, esophageal, gastric), presbyphagia, pseudoachalasia, quinsy, radiation esophagitis/stricture, retropharyngeal abscess, Schatzki ring, scleroderma, Wilson disease, Zenker's diverticulum

Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease

Diphtheria, Lassa fever, rabies, snakebites, tetanus, tetrodotoxin

Musculoskeletal / Ortho No underlying causes
Neurologic

Amyotrophic lateral sclerosis, autonomic neuropathy, brain stem gliomas, bulbar palsy, central pontine myelinolysis, cerebellar Infarction, Chagas' disease, Guillain-Barre syndrome, lateral medullary syndrome, multiple sclerosis, myasthenia gravis, myotonic dystrophy, osmotic demyelination syndrome, paraganglioma, Parkinson's disease, pseudobulbar palsy, pseudodysphagia, vagus nerve palsy, Wallenbergs Syndrome

Nutritional / Metabolic

Plummer-Vinson syndrome

Obstetric/Gynecologic No underlying causes
Oncologic

Brain stem gliomas, esophageal cancer, oropharyngeal cancer, palate cancer, lung cancer, malignant mesothelioma

Opthalmologic

Oculopharyngeal muscular dystrophy

Overdose / Toxicity

Arsenic poisoning, fluoride poisoning, lead poisoning,

Psychiatric

Functional Dysphagia

Pulmonary

Lung cancer, malignant mesothelioma

Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy

Cervical osteophytes, inclusion body myositis, juvenile dermatomyositis, muscular dystrophy, oculopharyngeal muscular dystrophy, polymyalgia Rheumatica, polymyositis, trismus

Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order[2] [3]


References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Murray, J. (1999). Manual of Dysphagia Assessment in Adults. San Diego: Singular Publishing.
  2. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  3. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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