Diagnosis
Esophagoscopy and laryngoscopy can give direct view of lumens. Esophageal motility study is useful in cases of esophageal achalasia and diffuse esophageal spasms. Exfoliative cytology can be performed on esophageal lavage obtained by esophagoscopy. It can detect malignant cells in early stage. Ultrasonography and CT scan are not very useful in finding causes of dysphagia, but can detect masses in mediastinum and aortic aneurysms. FEES (Fibreoptic endoscopic evaluation of swallowing), sometimes with sensory evaluation, is done usually by a Medical Speech Pathologist or Deglutologist. This procedure involves the patient eating different consistencies as above. Swallowing sounds and vibrations could be potentially used for dysphagia screening, but these approaches are in the early research stages. Differential diagnosis
All causes of dysphagia are considered as differential diagnoses. Some common ones are:
Esophageal atresia
Paterson-Kelly syndrome
Zenkers diverticulum
Esophageal varices
Benign strictures
Achalasia
Esophageal diverticula
Scleroderma
Diffuse esophageal spasm
Polymyositis
Webs and rings
Esophageal cancer
Eosinophilic esophagitis
Hiatus hernia, especially paraesophageal type
Dysphagia lusoria
Stroke
Fahrs disease
Wernicke encephalopathy
Charcot–Marie–Tooth disease
Parkinsons disease
Multiple sclerosis
Amyotrophic lateral sclerosis
Rabies
Cervical SpondylosisEsophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially, only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids, although, so far, there is no scientific study that proves that those thickened liquids are beneficial.
Dysphagia may manifest as the result of autonomic nervous system pathologies including stroke and ALS, or due to rapid iatrogenic correction of an electrolyte imbalance.In older adults, presbyphagia - the normal healthy changes in swallowing associated with age - should be considered as an alternative explanation for symptoms. Treatments
There are many ways to treat dysphagia, such as swallowing therapy, dietary changes, feeding tubes, certain medications, and surgery. Treatment for dysphagia is managed by a group of specialists known as a multidisciplinary team. Members of the multidisciplinary team include: a speech language pathologist specializing in swallowing disorders (swallowing therapist), primary physician, gastroenterologist, nursing staff, respiratory therapist, dietitian, occupational therapist, physical therapist, pharmacist, and radiologist. The role of the members of the multidisciplinary team will differ depending on the type of swallowing disorder present. For example, the swallowing therapist will be directly involved in the treatment of a patient with oropharyngeal dysphagia, while a gastroenterologist will be directly involved in the treatment of an esophageal disorder. Treatment strategies
The implementation of a treatment strategy should be based on a thorough evaluation by the multidisciplinary team. Treatment strategies will differ on a patient to patient basis and should be structured to meet the specific needs of each individual patient. Treatment strategies are chosen based on a number of different factors including diagnosis, prognosis, reaction to compensatory strategies, severity of dysphagia, cognitive status, respiratory function, caregiver support, and patient motivation and interest. Oral vs. nonoral feeding
Adequate nutrition and hydration must be preserved at all times during dysphagia treatment.