Differential Diagnosis for Difficulty Swallowing in a 60-Year-Old
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is common in older adults and can cause symptoms of dysphagia (difficulty swallowing) due to chronic inflammation and irritation of the esophagus, leading to narrowing or spasm.
Other Likely Diagnoses
- Esophageal Stricture: Narrowing of the esophagus due to chronic inflammation or scarring, often from long-standing GERD, can cause liquids to feel stuck in the throat.
- Achalasia: A motility disorder of the esophagus characterized by the inability of food to pass through the esophagus and into the stomach, leading to dysphagia.
- Esophagitis: Inflammation of the esophagus, which can be caused by infection, allergies, or chemical irritation, leading to difficulty swallowing.
- Oral or Pharyngeal Dysphagia: Difficulty initiating swallows due to neurological or muscular issues affecting the mouth or pharynx.
Do Not Miss Diagnoses
- Esophageal Cancer: Although less common, esophageal cancer can present with progressive dysphagia, initially to solids and then to liquids, and is critical to diagnose early due to its poor prognosis if left untreated.
- Stroke or Other Neurological Disorders: Conditions affecting the brain or nervous system can lead to dysphagia due to impaired coordination of swallowing muscles.
- Pulmonary Aspiration: Difficulty swallowing can lead to aspiration of food or liquids into the lungs, potentially causing pneumonia or other respiratory complications.
Rare Diagnoses
- Eosinophilic Esophagitis: A chronic inflammatory disease of the esophagus that can cause dysphagia, food impaction, and narrowing of the esophagus.
- Scleroderma: An autoimmune disease that can affect the esophagus, leading to dysmotility and dysphagia.
- Zenker's Diverticulum: A rare condition where a pouch forms in the pharynx, which can trap food and cause difficulty swallowing.
- Foreign Body Obstruction: Although more common in children, adults can also experience obstruction due to accidentally ingesting a foreign object.