Dysphagia is difficulty swallowing that can be caused by issues in the oral, pharyngeal, or esophageal phases of swallowing. Pre-esophageal causes include disturbances in mastication, lubrication, tongue mobility, or the palate. Pharyngeal issues include obstructive lesions, infections, spasms, or paralysis. Esophageal causes involve the lumen, wall, or external compression and include strictures, tumors, motility disorders, or diverticula. Investigations include history, examination, imaging like barium swallow, and tests like manometry and pH studies to evaluate motility or acid reflux. Endoscopy allows direct visualization and biopsy of the esophagus.

1. DYSPHAGIA

2. •Dysphagia is difficulty in swallowing.
•The term ‘’odynophagia’’ is used when swallowing
causes pain.
•in ulcerative and inflammatory lesions of food
passages-oral cavity, oropharynx and
oesohagus
•. AETIOLOGY
•Cause;
- Pre-oesophageal (ie, disturbance in the oral or
pharyngeal phase of deglutition)
- Oesophageal (ie, disturbance in the Oesophageal
phase)

3. • PREOESOPHAGEAL CAUSES
• 1. Oral phase
1. Disturbance in mastication : Trismus, fractures of mandible,
Tumors of upper or lower jaw and disorders of
temperomandibular joints
2. Disturbance in lubirication : Xerostomia following
radiotherapy, Mikulicz’s disease, sjogren’s disease
3. Disturbance in mobility of the tongue : Paralysis of tongue,
painful ulcers, tumors of tongue, lingual abscess, total
glossectomy
4. Defect palate : Cleft palate, oronasal fistula
5. Lesions of buccal cavity and floor of the mouth :
stomatitis,ulcerative lesions,ludwig’s angina

4. 2. Pharyngeal phase:
1. Obstructive lesions of pharynx : Tumors of tonsil, soft palate,
pharynx, base of the tongue, supraglottic larynx, obstructive
hypertrophic tonsils.
2. Inflammatory conditions : acute tonsillitis, peritonsillar abscess,
retro or parapharyngeal abscess, acute epiglottitis, edema
larynx.
3. Spasmodic conditions: e.g. tetanus, rabies
4. Paralytic conditions : Paralysis of soft palate due to diphtheria,
bulbar palsy, cerebrovascular accidents.They cause regurgitation
into the nose.
Paralysis of larynx, lesions of vagus and bilateral superior
laryngeal nerves cause aspiration of food into the larynx.

5. •ESOPHAGEAL CAUSES
•Lesions may lie in the lumen, wall or outside the
wall of oesophagus
1. Lumen: Obstruction to lumen can occur in
atresia, foreign body, Strictures, benign or
malignant tumors.
2. Wall : acute or chronic oesophagitis, motility
disorders
• Hypo motility disorders: achalasia,
scleroderma, amyotrophic lateral sclerosis
•Hyper motility disorders: cricopharyngeal
spasms, diffuse oesophagal spasms

6. 3.Outside the wall: obstruction by pressing on the
oesophagus from outside.
• Hypopharyngeal diverticulum
• hiatus hernia.
• Cervical osteophytes
• Thyroid lesions
• Mediastinal lesions
• Vascular rings (dysphagia lusoria)

7. • INVESTIGATIONS
1. HISTORY
• Sudden onset: foreign body or impaction of food on preexisting
stricture or malignancy,
Neurological disorders.
• Progressive: Malignancy
• Intermittent: Spasms or spasmodic episodes over an organic
lesion
• More to liquids: Paralytic lesions
• More to solids and progressing even to liquids: Malignancy or
stricture
• Intolerance to acid food or fruit juices: ulcerative lesions
• Note any associated symptoms eg; regurgitation and heart burn,
regurgitation of undigested food while lying down with cough at
night, aspiration into lungs, aspiration into the nose.

8. 2.. CLINICAL EXAMINATION:
• Examination of oral cavity, oropharynx and larynx and
hypopharynx
• Examination of neck, chest, and nervous system including
cranial nerves
3. BLOOD EXAMINATION:
• Hemogram is important in the diagnosis and treatment
of Plummer-Vinson syndrome and to know the
nutritional status of patient

9. 4. RADIOGRAPHY:
• X-ray chest. To exclude cardiovascular, pulmonary and
mediastinal diseases.
• Lateral neck view: To exclude cervical osteophytes, and
any soft tissue lesions of postcricoid or retropharyngeal
space.
• Barium swallow: diagnosis of malignancy, cardiac
achalasia, strictures, diverticula, hiatus hernia, or
oesophageal spasms

10. 5. MANOMETRIC AND pH STUDIES.
• A pressure transducer along with a ph electrode and an
open-tipped catheter is introduced into the esophagus to
measure the pressures in the oesophagus and at its
sphincters
• Acid reflex into the oesophagus is measured by ph
electrode.
• Help in motility disorders, gastro-oesophageal reflex and
to find whether spasms are spontaneous or acid induced.

12. 6. OESOPHAGOSCOPY :
It gives direct examination of oesophageal mucosa and
permits biopsy specimens.
7. OTHER INVESTIGATIONS:
Bronchoscopy
Cardiac catheterisation
Thyroid scan may require depending on the cause