Dysphagia resident survival guide: Difference between revisions
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{{familytree | | |~|~|~|~|~|~|~| G01 |~|~|~|~|~| | | | | | |~|~|~|~|~|~|~|~| G02 |~|~|~|~|~|~|~| |G01=[[Manometry]]|G02=[[Endoscopy]] (+/-esophageal [[biopsy]]}} }} | {{familytree | | |~|~|~|~|~|~|~| G01 |~|~|~|~|~| | | | | | |~|~|~|~|~|~|~|~| G02 |~|~|~|~|~|~|~| |G01=[[Manometry]]|G02=[[Endoscopy]] (+/-esophageal [[biopsy]]}} }} | ||
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{{familytree | | | | | | | | | | | | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | I02 | | | | |I02=[[Esophagogram|Barium Swallow]]<br>• When endoscopy findings are normal<br>• When endoscopy is contraindicated due to history of prior radiation, [[caustic]] injury, complex [[esophageal stricture|stricture]] or surgery for [[esophageal cancer|esophageal]]/[[laryngeal cancer]]<br>• B When endoscopy access is limited}} | ||
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Revision as of 19:56, 4 August 2020
| Dysphagia Resident Survival Guide |
|---|
| Overview |
| Causes |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. There are no known life-threatening causes of dysphagia.
Common Causes
Depending upon the type of dysphagia, the causes can be categorized into two subsections:[1][2][3][4][5][6]
Common Causes of Oropharyngeal Dysphagia
| Common causes of oropharyngeal dysphagia | |||
|---|---|---|---|
| Neuromuscular disorders | Mechanical and obstructive causes | Medication side effects | Others |
|
Medications that reduce salivary flow:
|
| |
Common Causes of Esophageal Dysphagia
The common causes of esophageal dysphagia can be divided into four categories.[7][8][9][10][11]
| Structural (Mechanical) disorders | Motor disorders | Esophageal tumors | Systemic diseases | Miscellaneous | ||||
|---|---|---|---|---|---|---|---|---|
| Intrinsic compression | Extrinsic Compression | Primary | Secondary | |||||
Mucosal rings and webs
|
Strictures: | Vascular compression:
|
|
|
|
| ||
Less Common Causes
Less common causes of dysphagia include:
- Scleredema adultorum[12][13]
- Post chemotherapy and radiation therapy[14]
- Descending thoracic aorta aneurysm[15]
- Hypertrophy of cricopharyngeal muscles[16]
To review a complete list of dysphagia causes, click here
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
| Patient with Dysphagia | |||||||||||||||||||||||||||||||||
| Difficulty in initiating a swallow associated with cough, choking or nasal regurgitation | Sensation of food stuck in esophagus (seconds after initiating swallow) | ||||||||||||||||||||||||||||||||
| Oropharyngeal dysphagia | Esophageal dysphagia | ||||||||||||||||||||||||||||||||
Shown below is an algorithm summarizing the diagnosis of Esophageal dysphagia according the the World Gastroenterology Organisation Global Guidelines and Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia.[1][6]
}}| Esophageal dysphagia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Dysphagia to solids and liquids | Dysphagia to solids(may progress to liquids) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Motility disorders | Mechanical obstruction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intermittent | Progressive | Acute | Intermittent | Progressive | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Chronic heartburn | Regurgitation and/or respiratory symptoms | Chronic heartburn | Elderly (>50 years old), weight loss, anemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary motility disorders | Secondary motility disorders | Scleroderma | Achalasia | Foreign body | Esophageal ring or eosinophilic esophagitis | Esophageal stricture due to GERD | Esophageal or cardia carcinomas | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Manometry | Endoscopy (+/-esophageal biopsy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Barium Swallow • When endoscopy findings are normal • When endoscopy is contraindicated due to history of prior radiation, caustic injury, complex stricture or surgery for esophageal/laryngeal cancer • B When endoscopy access is limited | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 Malagelada, Juan-R.; Bazzoli, Franco; Boeckxstaens, Guy; De Looze, Danny; Fried, Michael; Kahrilas, Peter; Lindberg, Greger; Malfertheiner, Peter; Salis, Graciela; Sharma, Prateek; Sifrim, Daniel; Vakil, Nimish; Le Mair, Anton (2015). "World Gastroenterology Organisation Global Guidelines". Journal of Clinical Gastroenterology. 49 (5): 370–378. doi:10.1097/MCG.0000000000000307. ISSN 0192-0790.
- ↑ Cook, Ian J.; Kahrilas, Peter J. (1999). "AGA technical review on management of oropharyngeal dysphagia". Gastroenterology. 116 (2): 455–478. doi:10.1016/S0016-5085(99)70144-7. ISSN 0016-5085.
- ↑ Philpott, Hamish; Garg, Mayur; Tomic, Dunya; Balasubramanian, Smrithya; Sweis, Rami (2017). "Dysphagia: Thinking outside the box". World Journal of Gastroenterology. 23 (38): 6942–6951. doi:10.3748/wjg.v23.i38.6942. ISSN 1007-9327.
- ↑ Espitalier, F.; Fanous, A.; Aviv, J.; Bassiouny, S.; Desuter, G.; Nerurkar, N.; Postma, G.; Crevier-Buchman, L. (2018). "International consensus (ICON) on assessment of oropharyngeal dysphagia". European Annals of Otorhinolaryngology, Head and Neck Diseases. 135 (1): S17–S21. doi:10.1016/j.anorl.2017.12.009. ISSN 1879-7296.
- ↑ Abdel Jalil, Ala' A.; Katzka, David A.; Castell, Donald O. (2015). "Approach to the Patient with Dysphagia". The American Journal of Medicine. 128 (10): 1138.e17–1138.e23. doi:10.1016/j.amjmed.2015.04.026. ISSN 0002-9343.
- ↑ 6.0 6.1 Liu, Louis W C; Andrews, Christopher N; Armstrong, David; Diamant, Nicholas; Jaffer, Nasir; Lazarescu, Adriana; Li, Marilyn; Martino, Rosemary; Paterson, William; Leontiadis, Grigorios I; Tse, Frances (2018). "Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia". Journal of the Canadian Association of Gastroenterology. 1 (1): 5–19. doi:10.1093/jcag/gwx008. ISSN 2515-2084.
- ↑ Xiao Y, Kahrilas PJ, Nicodème F, Lin Z, Roman S, Pandolfino JE (2014). "Lack of correlation between HRM metrics and symptoms during the manometric protocol". Am J Gastroenterol. 109 (4): 521–6. doi:10.1038/ajg.2014.13. PMC 4120962. PMID 24513804.
- ↑ Enestvedt BK, Williams JL, Sonnenberg A (2011). "Epidemiology and practice patterns of achalasia in a large multi-centre database". Aliment Pharmacol Ther. 33 (11): 1209–14. doi:10.1111/j.1365-2036.2011.04655.x. PMC 3857989. PMID 21480936.
- ↑ Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC (1992). "Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh". Gut. 33 (8): 1011–5. PMC 1379432. PMID 1398223.
- ↑ Pandolfino JE, Gawron AJ (2015). "Achalasia: a systematic review". JAMA. 313 (18): 1841–52. doi:10.1001/jama.2015.2996. PMID 25965233.
- ↑ Gockel I, Lord RV, Bremner CG, Crookes PF, Hamrah P, DeMeester TR (2003). "The hypertensive lower esophageal sphincter: a motility disorder with manometric features of outflow obstruction". J Gastrointest Surg. 7 (5): 692–700. PMID 12850684.
- ↑ Chatterjee S, Hedman BJ, Kirby DF (2017). "An Unusual Cause of Dysphagia". J Clin Rheumatol. doi:10.1097/RHU.0000000000000666. PMID 29280826.
- ↑ Wright RA, Bernie H (1982). "Scleredema adultorum of Buschke with upper esophageal involvement". Am J Gastroenterol. 77 (1): 9–11. PMID 7064968.
- ↑ Nguyen NP, Sallah S, Karlsson U, Antoine JE (2002). "Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues". Cancer. 94 (4): 1131–41. PMID 11920484.
- ↑ Conte, Blagio A. (1966). "Dysphagia Caused by an Aneurysm of the Descending Thoracic Aorta". New England Journal of Medicine. 274 (17): 956–957. doi:10.1056/NEJM196604282741710. ISSN 0028-4793.
- ↑ Benedict, Edward B.; Sweet, Richard H. (1955). "Dysphagia Due to Hypertrophy of the Cricopharyngeus Muscle or Hypopharyngeal Bar". New England Journal of Medicine. 253 (26): 1161–1162. doi:10.1056/NEJM195512292532607. ISSN 0028-4793.