Structural dysphagia

(solids >liquids; JAMA 2015;313:18; Gastro 2018;155:1022)

Oropharyngeal

• Zenker’s divertic.
• Malignancy; proximal strictures/rings/webs; infection; radiation injury; goiter; osteophytes

Esophageal

• Rings:

  • (intermittent dysphagia, concentric obstructing tissue, Schatzki ring):
  • near GE jxn, a/w food impaction, linked to GERD;
  • Rx w/ PPI, dilation

• Webs:

  • thin, partially occlusive structure,
  • proximal,
  • a/w Fe defic. (Plummer-Vinson synd.)

• Peptic or XRT strictures, foreign body, tumor, vascular rings (dysphagia lusoria), compression from dilated left atrium compression

• Infxn esophagitis: odynophagia > dysphagia; often immunosupp w/ Candida, HSV, CMV

• Pill esophagitis: odynophagia > dysphagia; NSAID, KCl, bisphosp., doxy & tetracycline

• Eosinophilic esophagitis

• Esophageal Dysphagia: The causes of esophageal dysphagia can be categorized as structural disorders or motility disorders.

• Structural disorders include the following:

  • intrinsic esophageal obstruction
    • strictures related to esophagitis or malignancy
  • extrinsic esophageal stricture
    • vascular anomaly
    • malignancy/mass in chest or mediastinum
  • esophageal rings and webs
    • Plummer–Vinson syndrome (esophageal ring)
    • Schatzki ring
  • food impaction

• Motility disorders can be categorized as primary and secondary esophageal motility disorders as defined in the following table.

Neuromuscular dysphagia