causes of dysphagia

Etiology: 1) mechanical dysphagia 1) luminal a) large bolus b) foreign body 2) intrinsic narrowing of lumen a) inflammatory conditions causing edema & swelling 1] stomatitis 2] pharyngitis/epiglottitis 3] esophagitis a] viral: Herpes simplex, Herpes zoster, cytomegalovirus b] bacterial c] fungal (Candida) d] mucocutaneous bullous disease e] caustic chemical, thermal injury b) webs & rings 1] pharyngeal (Plummer-Vinson syndrome) 2] esophageal (congenital, inflammatory) 3] lower esophageal mucosal (Schatzki) ring c) benign strictures 1] peptic 2] caustic & pill-induced 3] inflammatory a] Crohn's disease b] candidiasis c] mucocutaneous lesions 4] ischemic 5] postoperative, postirradiation 6] congenital d) benign tumors 1] leiomyoma 2] lipoma 3] angioma 4] inflammatory fibroid polyp 5] epithelial papilloma e) malignant tumors 1] primary cancer a] squamous cell carcinoma b] adenocarcinoma c] carcinosarcoma d] pseudosarcoma e] lymphoma f] melanoma g] Kaposi's sarcoma 2] metastatic cancer 3) extrinsic compression a) cervical spondylitis b) vertebral osteophytes c) retropharyngeal abscess or mass d) enlarged thyroid gland e) Zenker's diverticulum f) vascular compression 1] aberrant right subclavian artery 2] right-sided aorta 3] left atrial enlargement 4] aortic aneurysm g) posterior mediastinal mass h) pancreatic tumor or pancreatitis i) postvagotomy hematoma & fibrosis 2) motor (neuromuscular dysphagia) a) difficulty in initiating swallowing reflex - oral lesions & paralysis of tongue - oropharyngeal anesthesia - xerostomia (Sjogren's syndrome) - lesions of sensory components of cranial nerves 10 & 12 - lesions of swallowing center b) disorders of pharyngeal & esophageal striated muscle - muscle weakness - lower motor neuron lesion (bulbar paralysis) - cerebrovascular accident - motor neuron disease - poliomyelitis, postpolio syndrome - polyneuritis - amyotrophic lateral sclerosis (ALS) - familial dysautonomia - neuromuscular (myasthenia gravis) - muscle disorders - polymyositis - dermatomyositis - myopathy: myotonic dystrophy, oculopharyngeal myopathy - disordered contractions - pharynx & upper esophagus - rabies - tetanus - extrapyramidal disorders - upper motor neuron lesions (pseudobulbar paralysis) - upper esophageal sphincter - paralysis of suprahyoid muscles - cricopharyngeal achalasia c) disorders of esophageal smooth muscle - weak esophageal contractions - scleroderma & other connective tissue disorders - hollow visceral myopathy - metabolic neuromyopathy (amyloid, alcohol? diabetes?) - achalasia - disordered esophageal contractions - esophageal body - diffuse esophageal spasm - achalasia - variants of diffuse esophageal spasm - lower esophageal sphincter - disorders of achalasia: - Chagas' disease,carcinoma, lymphoma, toxins & drugs - lower esophageal muscular (contractile) ring 3) medications (see medications causing dysphagia)

References

Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 207