Etiology

Dysphagia can result from a variety of structural, neurological, muscular, or functional abnormalities.

1. Oropharyngeal Dysphagia (Difficulty Initiating Swallow)

Caused by problems in the oropharynx and proximal esophagus.

Neurological Causes

  • Stroke (ischemic or hemorrhagic)
  • Parkinson's disease
  • Amyotrophic lateral sclerosis (ALS)
  • Multiple sclerosis (MS)
  • Traumatic brain injury
  • Cerebral palsy
  • Bulbar or pseudobulbar palsy

Muscular Causes

  • Myasthenia gravis
  • Polymyositis or dermatomyositis
  • Muscular dystrophies

Structural Causes

  • Zenker's diverticulum
  • Oropharyngeal tumors or masses
  • Radiation-induced fibrosis
  • Postsurgical changes

Other

  • Aging-related sarcopenia
  • Xerostomia (dry mouth due to medications, Sjögren’s syndrome, etc.)

2. Esophageal Dysphagia (Difficulty Swallowing Once Food Leaves the Oropharynx)

Caused by problems in the esophagus or lower esophageal sphincter (LES).

Mechanical/Structural Causes

  • Intrinsic obstructions:

    • Esophageal strictures (peptic, caustic, or due to eosinophilic esophagitis)
    • Esophageal cancer
    • Schatzki ring
    • Esophageal webs (e.g., Plummer-Vinson syndrome)
    • Foreign body impaction

  • Extrinsic compressions:

    • Mediastinal tumors
    • Enlarged thyroid (goiter)
    • Vascular anomalies (e.g., dysphagia lusoria caused by aberrant subclavian artery)

Neuromuscular/Motility Disorders

  • Achalasia
  • Diffuse esophageal spasm
  • Hypercontractile esophagus (jackhammer esophagus)
  • Hypocontractile esophagus (scleroderma, diabetic esophageal dysmotility)

Inflammatory Causes

  • Esophagitis (reflux-related, infectious, eosinophilic, or due to medication injury)

3. Psychogenic or Functional Dysphagia

  • Globus sensation (a subjective feeling of a lump in the throat without an actual obstruction)
  • Psychogenic disorders (e.g., somatization disorder, anxiety)

Evaluation Considerations

  • History: Sudden vs. progressive onset, associated pain, regurgitation, or aspiration.
  • Imaging and Tests:
    • Modified barium swallow (oropharyngeal dysphagia)
    • Esophagram or upper GI series
    • Esophageal manometry
    • Endoscopy

 

 

Dysphagia

Digital World Medical School
© 2025