Dysphagia

Dysphagia is difficulty swallowing; odynophagia, painful swallowing. Swallowing is achieved in three stages: a) involuntary movement of the food bolus to the pharynx, with relaxation of the upper esophageal sphincter and cricopharyngeal muscle; b) reflex (involuntary) propulsion of food by the pharynx by means of contraction waves, and c) transport of the bolus through the esophagus to the stomach, by means of positive pressure waves (primary peristalsis), followed by reflex relaxation of the lower esophageal sphincter.

Causes

Dysphagia is due to motility disorders as well as mechanical obstruction. Oropharyngeal causes include disorders of the mouth, upper respiratory tract or pharyngeal, as well as anatomical, neoplastic, infectious and neurological entities. The main esophageal causes are carcinoma, esophagitis, achalasia, contractile ring, diffuse spasm, Zenker's diverticulum, scleroderma, extrinsic masses, paraesophageal hernias, esophageal membrane, stenosis, vascular anomalies and emotional disorders. Occasionally, gastroesophageal reflux results in upper esophageal sphincter spasm and dysphagia.

Clinical evaluation

The history should include duration, location and the time when the problem arises in relation to food intake. The physician should find out the degree of weight loss and the presence of concomitant vomiting. It is necessary to explore cervical nodes, stigmas of scleroderma and lesions of the mouth. Diagnostic studies include contrast esophagogastroduodenal transit, manometry, and esophagoscopy with biopsy.

Hiccup

It is usually a benign nuisance due to gastric distension, alcohol, temperature changes and tobacco. It is also sometimes due to vagal diaphragmatic irritations. It may depend on trauma, tumor, inflammation, or infection. Intra-abdominal vagal stimulation can be due to distension, biliary affection or peptic ulcer, surgical manipulations, trauma or intestinal obstruction. Subphrenic abscesses, hiatal hernias, and eventration can stimulate the phrenic nerve. You may rely on various toxins, drugs, and metabolic disorders. Treatment targets the underlying cause.