Guideline sources The following summarized guidelines for the evaluation and management of esophageal dysphagia are prepared by our editorial team based on guidelines from the Canadian Association of Gastroenterologists (CAG 2018). 1 2 2 3 4 Definition Esophageal dysphagia is characterized by difficulty transporting food down the esophagus due to involvement of the esophageal body and esophagogastric junction. 2 Epidemiology Esophageal dysphagia is caused by structural or inflammatory abnormalities (strictures, rings, webs, malignancy, reflux esophagitis, eosinophilic esophagitis) and motility disorders (achalasia, ineffective esophageal motility, esophageal spasm, esophagogastric junction outflow obstruction). 2 Disease course Clinical manifestations of esophageal dysphagia include difficulty swallowing solids and liquids, intermittent or progressive dysphagia, food bolus impaction, food regurgitation, heartburn, weight loss, anorexia, respiratory distress, hypotension, and atypical chest pain. 3 Prognosis and risk of recurrence Annual mortality associated with GERD is 0.46 per 100,000 individuals. 4 https://web.pathway.md/diseases/rec9Ot9rr5kLFbhao 1/3 6/29/23, 4:19 AM Esophageal dysphagia Pathway Guidelines 1. Diagnostic investigations Clinical assessment: identify patients with oropharyngeal dysphagia according to presenting symptoms and physical examination. B Show 2 more Barium esophagram: consider obtaining a barium esophagram in some patients with esophageal dysphagia when there is limited local access to endoscopy, in order to assess for significant structural lesions and facilitate timely referral to urgent endoscopy and specialist consultation. B 2. Diagnostic procedures Upper GI endoscopy: Obtain upper gastrointestinal endoscopy as the initial test to maximize diagnostic yield in patients with persistent esophageal dysphagia. B Perform esophageal biopsies to detect mucosal pathology in all patients undergoing endoscopy for esophageal dysphagia, unless there are clear features of erosive reflux esophagitis. B Esophageal manometry: obtain esophageal manometry to evaluate for esophageal motility disorders in patients with persistent esophageal dysphagia in whom structural and inflammatory causes have been ruled out. B 3. Medical management Proton pump inhibitors: Provide a diagnostic and therapeutic trial of an oral PPI (given BID) in patients < 50 years of age presenting with esophageal dysphagia and reflux symptoms, in whom there are no alarm features to suggest underlying malignancy (bleeding, odynophagia, weight loss, or vomiting). B Obtain further testing if dysphagia does not resolve completely after a 4-week trial acid suppression therapy in patients with esophageal dysphagia in whom a trial of a PPI was initiated. B Clinical findings Patient demographics Symptoms Elderly age Bringing back up undigested food Past medical history Cough Dysphagia Esophageal tumors Food regurgitation Exposure to radiation therapy https://web.pathway.md/diseases/rec9Ot9rr5kLFbhao 2/3 6/29/23, 4:19 AM Esophageal dysphagia Pathway Heartburn Gastroesophageal reflux Hoarseness Scleroderma Muscle spasms Endoscopic findings Weight loss Esophageal foreign body Head and neck exam Drooling References 1. Louis WC. Liu, Christopher N. Andrews, David Armstrong et al. Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia. Journal of the Canadian Association of Gastroenterology, 2018, 1 1 , 5 19. Open 2. Louis W C Liu, Christopher N Andrews, David Armstrong et al. Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia. 2018 Feb 9;1 1 5 19.2018 Feb 9;1 1 5 19. Open 3. Prianka Chilukuri, Florence Odufalu, Christine Hachem. Dysphagia. May-Jun 2018;115 3 206 210.May-Jun 2018;115 3 206 210. Open 4. Tuomo K Rantanen, Eero I T Sihvo, Jari V Rasanen et al. Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment. 2007 Feb;102 2 246 53.2007 Feb;102 2 246 53. Open 5. Louis W C Liu, Christopher N Andrews, David Armstrong et al. Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia. J Can Assoc Gastroenterol. 2018 Apr; 1 1 5 19. Open 6. Prianka Chilukuri, Florence Odufalu, Christine Hachem. Dysphagia. Mo Med. 2018 May-Jun; 115 3 206 210. Open 7. Tuomo K Rantanen, Eero I T Sihvo, Jari V R s nen et al. Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment. Am J Gastroenterol. 2007 Feb;102 2 246 53. Open https://web.pathway.md/diseases/rec9Ot9rr5kLFbhao 3/3