Clinical Pearl Wednesday #76

Achalasia Achalasia Causes  - naturalherbsclinic / Pixabay

Have a patient complaining of dysphagia? It is critically important you determine if it is stemming from an oropharyngeal or esophageal etiology. This will guide the test that is ordered.

If it is oropharyngeal in nature, the patient will usually have a prior history of a CVA or neuromuscular disorder. The patient will usually have difficulty with the initiation of swallowing, they can aspirate regularly, and they can have nasal regurgitation.

On the other hand, if it is esophageal in nature, they will feel the difficulty in the lower sternum area. Typically, these patients will need to drink a lot of water to get the food down. Often times, there will be associated heartburn as well.

Additionally, if the patient can get fluids down but not solids, this can indicate an obstructive etiology such as a tumor. If the patient cannot get fluids or solids down, then be thinking of a neuromuscular etiology.

Regardless, these patients need urgent referral to GI or neurology depending on the cause. As always, use your own clinical judgement.

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