Clinical Methods
Walker HK, Hall WD, Hurst JW, editors.Boston: Butterworths; 1990.
A careful history is of critical importance in the evaluation of the patient with dysphagia because approximately 80% of esophageal disorders can be diagnosed by history alone.
The examiner should ask the patient to describe the symptoms in his or her own words. The patient should be asked specific questions relating to dysphagia. This should generally proceed as follows: "Do you have diffi-culty swallowing?" "Is it for solids, liquids, or both?""Can you localize the dysphagia?" Usually, the patient can point to a location in the retrosternal area. This localization is helpful"How long has the swallowing difficulty been present?" "Is it new, or chronic and recurrent with intervening periods of normal swallowing?"
Oropharyngeal dysphagia occurs when there is difficulty moving the food bolus from the oral cavity to the cervical esophagus. Normal oropharyngeal swallowing requires a coordinated voluntary transfer of food from the mouth into the pharynx, followed by rapid transfer of the bolus into the upper esophagus. Symptoms relate to difficulty in the initiation or initial transport of a solid or liquid food bolus. This may include the sensation (and occurrence) of food sticking in the oral cavity or neck region, as well as symptoms of pulmonary aspiration. Various neuromuscular disorders are associated with this type of dysphagia, accounting for 75 to 85% of causes.
Oropharyngeal dysphagia results from neuromuscular disease in greater than three quarters of cases. The up-per esophageal sphincter is commonly involved. Aspiration is frequent, and pain may occur.