Dysphagia (Difficulty Swallowing)

  • Medical Author:
    Jay W. Marks, MD

    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.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    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.

What is the differential diagnosis for dysphagia?

Odynophagia and globus sensation. The occasional difficulty in distinguishing dysphagia from odynophagia already has been discussed as well as the difference between dysphagia and a globus sensation.

Tracheo-esophageal fistula. One disorder that can be confused with dysphagia is tracheo-esophageal fistula. A tracheo-esophageal fistula is an open communication between the esophagus and the trachea that often develops due to cancers of the esophagus but which may also occur as a congenital (inborn) birth defect. Swallowed food may provoke coughing that mimics the coughing due to dysfunction of the muscles of the pharynx that allows food to enter the larynx; however, in the case of a fistula, the coughing is due to the passage of food from the esophagus through the fistula and into the trachea.

Rumination syndrome. Rumination syndrome is a syndrome in which food regurgitates effortlessly back into the mouth after a meal is completed. It usually occurs in younger women and conceivably could be confused with dysphagia. There is no sensation of food sticking after swallowing, however.

Gastroesophageal reflux disease (GERD). People with more severe GERD may have food regurgitate from the stomach into the esophagus or mouth, particularly when activities increase pressure in the abdomen, for example, with coughing and bending. Regurgitation also may occur at night while persons with GERD are sleeping as in those with swallowing disorders who have food collect in their esophagus.

Heart disease. The spastic motility disorders that cause dysphagia can be associated with spontaneous chest pain, that is, chest pain not associated with swallowing. Despite the presence of dysphagia, spontaneous chest pain always must be assumed to be due to heart disease until heart disease has been excluded as the cause of the chest pain. Therefore, it is important to test carefully for heart disease before considering the esophagus as the cause of chest pain when a patient with dysphagia complains of episodes of spontaneous chest pain.

Medically Reviewed by a Doctor on 3/9/2016

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