Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
As discussed previously, there are many causes of dysphagia. For convenience,
causes of dysphagia can be classified into two groups;
that the cause is a problem in the mouth or pharynx) and
can be classified differently into several groups.
Physical obstruction of the pharynx or esophagus
Benign and malignant tumors of the pharynx and
esophagus. Most commonly these
tumors are malignant.
Tumors of the tissues surrounding the pharynx and esophagus. These tumors can
compress the pharynx and esophagus leading to obstruction. This is an unusual cause of dysphagia. An example would be
Narrowing (strictures) of the esophagus. The strictures usually are due to
GERD and are located in the lower esophagus. These strictures are the result of ulcerations of the
esophagus that heal, with scarring as a result. Less common causes of strictures
include ingestion of acid or lye during attempts at
suicide, some pill medications that may stick in the
esophagus and cause ulceration and scarring, for example,
potassium chloride ( K-Dur, K-Lor, K-Tab, Kaon CL, Klorvess, Slow-K, Ten-K, Klotrix, K-Lyte CL),
doxycycline (Vibramycin, Oracea, Adoxa, Atridox and others),
Gluconate, Quinidine Sulfate), biphosphonates used for treating
radiation therapy, and
infections of the lower esophagus, particularly in people with
Schatzki's rings. These rings are benign, very short narrowings (millimeters)
at the lower end of the esophagus. The cause of
Schatzki's rings is unknown though some
physicians believe they are caused by GERD.
Infiltrating diseases of the esophagus. The most common infiltrative disease
is a disease in which the wall of the esophagus fills with
eosinophils, a type of white blood cell involved in inflammation. This disease
is called eosinophilic esophagitis. The wall of the esophagus becomes stiff and cannot
stretch as the bolus of food passes. As a result, the bolus sticks.
Diverticuli (outpouchings) of the pharynx or esophagus. The diverticuli can
expand when it fills with swallowed food and can compress the pharynx or esophagus. The diverticuli can be
at the upper end of the esophagus (Zenker's diverticulum) or, less commonly, at the
middle or lower end of the esophagus.
Cricopharyngeal bars. These bars represent a part of the upper esophageal
sphincter that has hypertrophied, that is, expanded. The bar does not stretch normally as the
bolus passes. The cause of cricopharyngeal bars is unclear. Small bars that do not
interfere with swallowing are quite common.
Cervical osteophytes. Rarely,
arthritis of the neck results in an overgrowth
of bone that extends anteriorly out from a vertebra (an osteophyte). Since the vertebrae of the
neck lie immediately behind the lower pharynx and uppermost esophagus, the osteophyte
may impinge on the pharynx and esophagus.
Congenital abnormalities of the esophagus. These abnormalities are present
from birth and are almost always discovered in infants because of problems when oral feeding